Monday, April 30, 2012

USA - What Are the Experiences of Family Physicians With Their EHRs?

At the recent conference of the California Academy of Family Physicians, I had an opportunity to give a talk on various aspects of using health IT in clinical practice. 

One talk was on “High tech, high touch healthcare,” which focused on methods to avoid having the EHR get in the way of the interpersonal doctor-patient relationship. The other talk was on “Measuring patient engagement,” which looked at 3 domains of this question: (1) measuring patient experience (patient satisfaction), (2) on-line patient engagement, and (3) continuity of care between clinical settings.

Some interesting observations resulted from this interactive presentation, surveyed by that most unscientific method: a show of hands. Nevertheless, some of the trends seemed to ring true (at least qualitatively so).

How many family physicians have adopted and EHR? About 50-60% of the audience. This is a big leap from how things were 2 years ago.

Who chooses which EHR to use? About 1/3 of the respondents were in a position to choose the system they use themselves, and about 2/3 worked in settings (clinics) where the technology decision was made for them.

Do physicians love their EHR, hate it, or are somewhere in the middle? Among those who use an EHR, there was a passionate dichotomy – about half loved their system, about half hated theirs, and very few were in the middle. This correlates with a wider survey done recently by the CAFP showing a similar 50/50 split along the love/hate lines, with few in the middle.

Of those who hate their EHR, what are the things that are most bothersome? There seemed to be two main issues. (1) Everything costs, so adding Meaningful Use functionality costs extra (and often involves double-entry of data, into the core EHR and into the Meaningful Use module). Taking one’s data out of the EHR, when a rip-and-replace decision has been made to move to another product, is also costly (I heard around $2000). (2) Inflexibility of the EHR interface, often with stiff and immutable templating inputs, makes documentation difficult. Inability to modify a template oneself, or use multiple ways of data entry (free typing, dictation, flexible and customizable templating), result in sufficient slowdown such that productivity (=income) are impacted.

Though far from scientific, these anecdotal observations may be reasonably reflective of the state of EHR experience, at least among family physicians.

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