While doctors recognize the important advances that electronic health records have enabled, they have serious concerns about the negative impact that EHRs are currently having on their professional lives and patient care, according to a March 12 blog by the RAND Corporation. Moreover, physicians worry that EHRs are significantly more expensive than anticipated which is creating uncertainties about the sustainability of their use.

The blogger, Mark Friedberg, a RAND natural scientist and a practicing general internist, provides the results of a RAND study on professional satisfaction sponsored by the American Medical Association. Doctors "described poor EHR usability that did not match clinical workflows, time-consuming data entry, interference with face-to-face patient care, and overwhelming numbers of electronic messages and alerts," writes Friedberg. "Physicians in a variety of specialties reported that their EHRs required them to perform tasks that could be done more efficiently by clerks and transcriptionists."

In addition, doctors voiced their disappointment with the "inability of EHRs to exchange health information electronically" which has forced them to rely on faxed medical documents from outside providers, states the blog. Physicians also expressed concerns about potential misuse of template-based notes which contain pre-formatted, computer-generated text," reports Friedberg.

Though these notes can improve the efficiency of data entry when used appropriately, he warns that "when used inappropriately, template-based notes were described as containing extraneous and inaccurate information about patients' clinical histories, with some physicians questioning the fundamental trustworthiness of a medical record containing such notes."

"If practicing physicians are correct, the current state of EHR technology has introduced several impediments to providing patient care, undermining physician professional satisfaction," concludes Friedberg. "Many of these problems–such as the proliferation of clinical information that doctors don't trust–also should be of great concern to patients. Patients, providers, payers, and vendors all have an interest in improving the usability of EHRs and integrating them into clinical workflows that produce better, more efficient care."

To address the problems physicians described in the RAND study, Friedberg states that the AMA is taking the following steps:

 * Organizing and leading an effort to work with the EHR vendor and EHR user communities to improve EHR usability.

* Helping physicians become better purchasers and users of EHRs to increase practice efficiency and augment physician-patient “face-time”.

* Continuing to work federal regulators to address usability concerns and resolve problems with the details and pace of certifying EHR systems and implementing “Meaningful Use” rules.

* Working to reduce the number and pace of requirements that EHR vendors must satisfy to receive federal certification, so that EHR vendors can better focus on improving the usability and functionality of their products in response to the needs of physicians and allied health professionals.

* Working with policymakers and others concerned about institutional liability to “liberalize” the ability to use office support personnel to reduce physician “clerical work” related to EHR use.

 Last month, in a letter to Health and Human Services Secretary Kathleen Sebelius, AMA and 47 other health care provider organizations said they fear success of the EHR program is jeopardized “if steps are not taken now to address our shared concerns.” The groups noted that 5,000 hospitals and 550,000 eligible physicians face meeting initial Stage 2 during the next seven months, but the industry isn’t ready for the new stage.

“With only a fraction of 2011 Edition products currently certified to 2014 Edition Standards, it is clear that the pace and scope of change have outstripped the ability of vendors to support providers,” according to the letter. “This inhibits the ability of providers to manage the transition to the 2014 Edition of certified electronic health records technology and Stage 2 in a safe and orderly manner.”

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