Almost Half of Physicians Say EHRs Have Hurt Quality of Care

Frellick M. Medscape. May 01, 2019. Available at: https://www.medscape.com/viewarticle/912340 (accessed 5/2/19)

Recently, Medscape conducted a poll titled “What Are the Pros and Cons of Your EHR?”. There were 273 respondents — 207 physicians and 66 nurses/APRNs. More physicians said that electronic health record (EHR) systems have decreased quality of care (44%) in their primary workplace than increased it (40%). Nurses and advanced practice registered nurses (APRNs) saw more benefit than detriment in EHRs: 42% said they had increased quality of care vs 35% who said they had decreased care quality.

A clue to the cause for the perception of a decrease in quality may be that few physicians or nurses were involved in the decision of which EHR to use in their primary workplace. Among physicians, only 28% had input in choosing the HER and only 2% of physicians, nurses, and APRNs said they had input into the decision and the system they wanted was chosen.

When asked what aspects of EHRs increased quality of care, the top answer among physicians was the ability to locate and review patient information more easily (59%), followed by the ability to electronically subscribe (49%), and portability/access to patient records by all members of the care team (44%). Portability and access by all on the team was the top reason given by nurses/APRNs for increases of care quality (62%), followed by ability to locate and review patient information more easily (60%), and ability to electronically prescribe (46%).

When physicians and nurses/APRNs were asked what aspects of EHRs decrease quality of care, they gave similar weight to these four reasons: added paperwork/charting; entering data during the patient encounter; lack of interoperability with other systems; and system failures or problems. A family medicine physician summarized what many doctors have said the field of medicine has lost in a decade with such a system — the nuances in narratives about the patient. They reduce "fascinating human stories to utterly boring, repetitious templates," he wrote.

The results of the iCOMPARE reported earlier this month suggest that the drift from face-to-face care is continuing with the next generation of physicians. First-year residents spend almost five times more hours on indirect patient care than on face-to-face patient care, and most of that time was spent working with EHRs.