Physicians see potential of EHRs despite early dissatisfaction

Several studies and surveys are finding that many physicians view electronic health record use like their patients might think of exercise. They don’t necessarily enjoy it while they are doing it, but they recognize and appreciate the benefits.

A survey of 613 physicians across multiple specialties by the Deloitte Center for Health Solutions found that 73% of physicians believe health information technology will improve the quality of care provided to patients in the long term. In fact, two-thirds of physicians already have an EHR in their practices capable of meeting the first stage of the meaningful use incentive program, the survey found. But only 15% say they are highly satisfied with their systems. Forty-eight percent said they were somewhat satisfied. Initiatives such as the meaningful use program and bundled payment and shared saving plans have helped contribute to the growing number of physicians who are using EHRs.

“There’s a widening gap between what adopters can do and what nonadopters can do,” said Harry Greenspun, MD, senior adviser of health care transformation and technology for the Deloitte Center for Health Solutions. “When we think about accountable care, value-based care, care coordination and population health, all of those hinge on having an EHR as a foundational aspect of care delivery. So many of the things physicians are moving toward require an EHR.”

Deloitte, which released its survey in May, found that most U.S. physicians believe meaningful use of EHRs will help improve efficiencies in the practice. When it comes to specific benefits, 67% of all physicians and 56% of primary care physicians believe there will be improved communication and care coordination due to the interoperability of their EHRs. Fifty-nine percent of all physicians and 63% of primary care doctors believe there will be clinical benefits to having immediately available data. Other perceived benefits include time savings through e-prescribing (67% of all and 78% of primary care doctors) and patient care improvements through clinical guideline prompts and faster lab results (56% of all and 64% of primary care doctors).

One area physicians did not see promise, however, was in reduced costs. Deloitte found 71% believe the promise of reduced costs from use of health IT was inflated, and that health IT adoption actually will cost a practice more.

The management consulting firm Accenture conducted a survey, also released in May, that found a dramatic increase in the number of physicians using EHRs, and a growing perception that they will have a positive impact on care.

“What our survey would say is that it’s becoming nearly impossible to really have a clinical practice without having some kind of medical record technology,” said Kaveh Safavi, MD, managing director of Accenture’s North America health business. Physicians are adopting the technology and believing that “over time they will continue to become more usable,” he said.

Waiting for improvements

Although the surveyed doctors believe that EHRs have great potential to improve care, physicians in other surveys have expressed frustration that they aren’t seeing those benefits yet. In March, AmericanEHR Partners released a survey of 4,279 physicians that found the rate of those “very dissatisfied” with their EHR systems increased from 11% to 21% from 2010 to 2012. The number of those satisfied with their systems declined from 39% in 2010 to 27% in 2012. AmericanEHR Partners, founded by the American College of Physicians, maintains a vendor-neutral database of EHR products and vendor ratings based on satisfaction reviews submitted by its member organizations, which include the American Medical Association.

“We absolutely know … products are not great yet,” said Alan Brookstone, MD, co-founder of AmericanEHR Partners. But, he added, one would be hard-pressed to find a physician who would go back to paper after using an EHR.

Dr. Brookstone said most physicians believe care will improve with EHR use, but “currently the system just [doesn’t] get it done in many cases, and I think that’s what frustrates people.” Part of the dissatisfaction comes from the challenges associated with the conversion to EHRs from paper and the workflow changes associated with that conversion, he said. Dr. Brookstone said the “sweet spot” of when the initial challenges start to dissipate and satisfaction starts to increase appears to be five years after implementation.

What is surprising, he said, is the tolerance people have for the shortcomings of EHR technology. “In certain aspects of medicine, there’s zero tolerance for error,” he said. “I think we’re just at a stage with EHR technology that there’s been a much higher tolerance for either usability that doesn’t really fit the need of the user or for error detection capabilities within these systems that are not quite right at this particular time.”