EHRs vs. the Docs: They Should Work for You, Not Against You

By Brenda Mooney, Special to AHC Media

COLUMBIA, MO – How patient information is displayed usually tops the list of physician complaints about their electronic health record systems. A new study looks at why that is and what can be done about it.

The report, published recently in The Journal of the American Board of Family Medicine, calls for a change in the design of EHR documentation to better meet the needs of medical providers.

For the study, University of Missouri researchers watched primary care physicians navigate EHRs when preparing for patient visits. Users were asked what parts of the clinical notes they found most and least important.

Overwhelmingly, study authors point out, physicians found the "assessment" and "plan" sections of notes section to be the most important and usually reviewed those first, while the "review of systems" section, which is required by Medicare and Medicaid for billing purposes, was considered to be the least valuable for patient care.

"Most physicians we observed skipped right to the assessment and plan sections, which include the diagnoses of the patient from the last visit and notes on how physicians planned to address the diagnoses," said lead author Richelle Koopman, MD, associate professor of family and community medicine at Missouri. "In addition, physicians expressed a lot of frustration about the poor utility of the 'review of systems' section and said it had little value in addressing patient care."

Background information in the article notes that, since the Health Information Technology for Economic and Clinical Health Act of 2009, about 78% of office-based physicians have adopted EHRs, yet only 38% report they are highly satisfied with their systems. In addition, many believe the way a patient's health information is displayed in EHRs reduces the efficiency and productivity of patient care, according to the study.

"While EHRs have granted physicians access to more information than ever before, they also include lots of extraneous information that does not contribute to the care of the patient," Koopman said.

Study authors say part of the problem is that, during the transition from paper charts to EHRs, the systems’ creators duplicated the paper charts electronically – even though the hard-copy documents already were difficult to navigate because of increasing federal and regulatory demands on required information.

Instead of redundant and cluttered information presented in an outdated fashion, Koopman suggests patient information become more organized to allow physicians to spend more time with their patients instead of scrambling through notes to find the most valuable information. That also would make billing more efficient and reduce medical errors, she added.

Other research, published recently in the Journal of the American Medical Association, said poor usability of several widely used EHRs could be caused by lack of adherence to testing standards.

Even though the U.S. Department of Health and Human Services' Office of the National Coordinator for Health Information Technology has established certification requirements to promote usability practices by EHR vendors as part of a meaningful use program, the process of meeting those requirements varies greatly, according to an analysis of the 50 largest companies.