An in-depth look into physician perspectives on EHR adoption in physician practices from the recent RAND study.
A recent RAND research report reveals that the current state of EHR technology significantly worsened professional satisfaction in multiple ways. The project sponsored by the American Medical Association (AMA) gathered data from 108 in-person interviews and received 447 written responses across 30 physician practices in six states: Colorado, Massachusetts, North Carolina, Texas, Washington, and Wisconsin.
- Positive benefits of EHR adoption
- EHR impact on time
- Clinical workflow impact
- Patient Engagement
- Lack of interoperability
- Meaningful Use criteria challenges
- Financial impact
- Ongoing EHR maintenance costs
- Clinical documentation
- Future of EHRs
Positive Benefits of EHR Adoption
There are certain efficiencies that one gains as a result of [EHRs], and universal accessibility is wonderful, particularly if you’re on call at night and get called from an [emergency room] in Topeka and need to share information and even fax them something right away, it’s real helpful. Those are features that are wonderful, and patients now expect it.
—cardiologist
When the system’s working well, I can get to information quickly and old notes quickly. … I do like that, and I like the immediacy of having the note right there and not waiting three or four days [asking], “When is my dictation coming?” I can route it and I can send it to somebody quickly. I can print it out right away and then get it to the nursing home.
—primary care physician
You have to go way back, but yes, it was paper for a while. We had charts. We shuttled charts around in between the offices. There’s no way in the world we’d go back to that. It seems barbaric now, but you would always get misplaced charts and things like that. Now, three of us in three different buildings can look at the chart at the same time. … It really is much, much better. I mean, there’s no way I would go back to the old paper stuff.
—primary care physician
[Paperwork] has gotten tremendously better since we developed our electronic medical record three years ago. You can pretty much be out of here by five. Or what I will do is I will go home, have dinner, and then pull out my laptop, and that’s the great thing about the electronic medical record, I can finish things that evening at my leisure.
—obstetrician/gynecologist
I think [the EHR is] fantastic. … A real EHR, one that actually gives you things in fields that are usable and useful, makes all the difference. I can click a button and I can see the blood pressures over time. I’m not like thumbing through pages to say, “What was your last blood pressure?” “Oh, and what was the one before that?” and then try to think about them. I click a button and [the EHR] graphs them for me. I can see trends. I can see what’s been happening. It is incredible in facilitating communication. I mean, we have a huge practice, … and we work together as a team. How would you do that on paper?
—primary care physician
One of the quality criteria has historically been, for the diabetic, how often are they getting their hemoglobin A1C. It’s a great measure, but now that we have the electronic medical record and we can see the discrete data, we can not only track, “Did the patient get it within the appropriate clinical parameter?” but we can also see where they are in the results and then track that over time. So as a patient comes to us, as a new patient, and diabetic, we are able to improve their result and improve their health just through our own medical management and then see that in the laboratory results.
—manager of a primary care practice
I think, if used correctly, [the EHR] definitely improves communication and helps in terms of patient care overall, with tracking what’s going on with the patient. I think it’s helped with patient-to-physician communication. I have a younger patient population but they love the email and, quite honestly, I have some 70- and 80-year-old patients who love the email features, who email me as well.
—primary care physician
Additionally there’s a very, very sophisticated electronic medical system, with [hundreds of] docs. I’m able to look at anybody’s note, anytime, on any patient that I’m interested in or that has seen me for something. I think it just erases a lot of potential for medical errors and so forth because everything is clearly documented, [and] there’s not handwriting issues and so forth.
—orthopedic surgeon
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