Dr. Oliver Mayorga recalls one time attending to a patient in the Westerly Hospital emergency room who was suffering from cancer.
The patient, a Rhode Island resident, had received treatment at Dana Farber Cancer Institute in Boston but couldn’t recall exactly what medications they were on or even what surgeries they had undergone.
“But what I was able to do was sit down, and within five minutes, I could see exactly what was done in Boston,” said Mayorga, the hospital’s chief medical officer. “I was able to rapidly get to the correct diagnosis and treat the patient.”
The introduction of electronic health records has revolutionized the way health care practitioners track patient information such as demographic data, lab results, insurance information, allergies, medication history and medical records.
EHRs are often confused with electronic medical records, and while there are similarities, electronic health records go beyond standard clinical data collected in a provider’s office. And despite the positives of EHRs, they do have a downside.
According to some studies, health care practitioners often spend too much time charting electronic health records via a computer or tablet and less time with patients. They have also been linked to stress and burnout among practitioners.
In one study published in the Journal of the American Medical Informatics Association, 4,197 practicing physicians in Rhode Island were surveyed on their use of health care information technology. The main outcome was self-reported burnout.
The study found that 26% of the physician respondents reported burnout. Among those using electronic health records, 70% reported stress related to health care information technology.
Dr. Jared Anderson, an emergency physician at Lifespan Corp. and a professor of emergency medicine at Brown University’s Warren Alpert Medical School, says there are clear benefits to electronic health records, allowing for better integration between health care systems with individual patients.
“It creates the ability to have much more clinical decision support, where health care data that might not be right in front of your face can be identified by a computer system and then brought to your attention in order to make sure the patients are getting good and safe care,” said Anderson, who is also director of clinical informatics for Brown Emergency Medicine.
Yet, Anderson notes, EHRs can hinder a clinician’s workflow and create more work or fatigue. For example, interruptive electronic alerts that attempt to give the physician useful information about a patient. They’re not always useful.
Sometimes, popup alerts appear on the electronic records warning a health care provider to complete a procedure that is routine practice, Anderson said, but each alert requires a confirmation that can force a doctor to navigate to a separate menu and click multiple buttons – a process that can take 10 to 15 seconds each time.
“Does not sound like much, but then you need to consider what happens at scale, when millions of patient encounters are disrupted in the same way every year,” he said. “That is a lot of time and money for no reason.”
He cites data from the American Medical Informatics Association suggesting that the amount of time that clinicians have taken to complete documentation on patients has doubled over the past 20 years. Anderson says as much as 50% of clinician time can be spent with the EHR, including writing orders, reviewing results, communicating and documenting clinical notes.
At this point, there’s no avoiding the documentation.
Reimbursements from insurance companies and governmental payers are dependent on thorough record keeping. “The care, arguably, is just as good, but you have to document all of it perfectly or you cannot claim revenue,” Mayorga said.
The most obvious consequence other than physician burnout is the financial cost for the health care system.
“Why would you want some of the most expensive personnel in the hospital spending hours clicking through menus when they could be seeing additional patients?” Anderson said. “The health care system implemented EHRs with the overall assumption that physician time is a ‘free’ or very low-cost resource, which is, of course, not true.”
What can be done about it?
Mayorga says every effort should be made to try to mitigate burnout.
Sophisticated systems such as the one at Westerly Hospital – which is owned by Connecticut-based Yale New Haven Health Services Corp. – track “pillow time,” the time physicians spend filling in EHRs at home.
“We know that is very detrimental to work-life balance,” Maryorga said. “So we try to identify those individuals and give them support mechanisms and systems to make sure they don’t have to do that.”
Doctors also acknowledge that many younger “digital native” clinicians interact with EHRs differently, looking to optimize the interaction rather than seeing it as a hindrance.
In fact, instruction on EHR use is now woven into courses at the Alpert Medical School, according to Dr. Steven Rougas, director of the school’s doctoring program.
In the future, Anderson would like to remove the burden of data entry on physicians.
“Data could be entered by patients themselves, automatically pulled from other health record sources, or be entered by other staff such as medical assistants and clerks,” Anderson said. “The answer comes down to a financial investment in the time of informatics experts and clinical end users to design more-efficient systems in the future.”