Electronic health records, and especially the computerized ordering of tests and procedures, have helped fuel a national epidemic of burnout among doctors, research shows.
“The clerical burden associated with electronic health records has been a major contributing factor to physician burnout, with computerized physician order entry as the biggest source of frustration,” says Dr. Tait Shanafelt, the lead author of a study on the issue and director of the Mayo Clinic Department of Medicine Program on Physician Well-Being.
Completing even the simplest task, Shanafelt says, can be a challenge: “When you’re just writing a prescription or ordering a test, you sometimes feel like you’re fighting a computer for five minutes to do something that used to take five seconds.”
Nearly half of U.S. doctors are burned out, and many believe electronic health records, or EHRs, are partly to blame. Sold to health systems nationwide on a promise of unprecedented efficiency, the computerized records are intended to streamline everything from bookkeeping and research to patient care. Ideally, they would allow doctors and health systems to capture information, analyze it and then quickly exploit the results to cut costs and improve service.
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This potential of electronic health records to transform health care sparked federal policymakers in 2009 to create an incentive program offering up to $27 billion to encourage doctors and hospitals to switch to EHRs from paper charts. Since 2008, the proportion of medical practices using electronic health records has soared from around 15 percent to more than 80 percent. Nearly all Medicare-accepting hospitals have adopted their use, according to the Centers for Medicare and Medicaid Services, and those that don’t face a substantial financial penalty.
But the tools now on the market have failed to live up to expectations. Instead as shown by survey results from Shanafelt and colleagues that were published in the journal Mayo Clinic Proceedings they have generated widespread exasperation among physicians, with 44 percent of respondents who used electronic health records reporting that they were dissatisfied or very dissatisfied with them. Forty-one percent disagreed or strongly disagreed with the notion that the records have improved patient care.
“So much of what we do is no longer actually caring for patients,” complains one Mayo Clinic physician, who asked that his name be withheld. “It’s computer entry done, by necessity, in front of the patient while taking the history. A friend of mine said it’s like texting while driving, because there’s a lot we miss.”
Younger physicians expressed greater satisfaction with electronic health records than did older doctors. Forty-six percent of those younger than 40 responded that they were satisfied with their EHR systems, compared with 38 percent of those 40 to 49, 32 percent of those 50 to 59 and 34 percent of those 60 and older.
A common complaint is that electronic health records add steps to each patient encounter and complicate other tasks. The survey’s findings bear this out, as 63 percent of physicians responded that EHRs fail to improve efficiency, and only 23 percent said efficiency increases with their use. A bit over a third of respondents believed that the amount of clerical time spent on tasks directly related to patient care was “reasonable.”
The work not only adds up, it often spills over into physicians’ leisure time, and can disrupt family life. Nearly two-thirds of physicians reported that they worked at least 50 hours a week, and roughly 1 in 5 worked nearly 70.
“The average physician spends two to three hours a day at home finishing up record-keeping,” says psychologist Wayne Sotile, founder of the Center for Physician Resilience in Davidson, North Carolina. “I work with a physician who works a 10-hour day in his clinic. His goal is to get home at midnight.”
Such anecdotes abound. Shanafelt and his colleagues wanted to examine the evidence, so using the American Medical Association’s Physician Masterfile, they carried out their national survey of U.S. physicians who were in active practice in 2014. Roughly 6,500 physicians completed the surveys, supplying information on their ages, specialties, practice settings and number of hours worked each week, along with other aspects of their lives.
The study found that electronic health records and computerized order entry make documentation and other clerical chores more burdensome for physicians. More than three-fourths of respondents said they used electronic health records. A similar percentage, among those who said computerized ordering was relevant to their specialty, put in for things like prescriptions, tests and procedures online.
Satisfaction with computer ordering was mixed, with 42 percent of those who used computer ordering saying they were dissatisfied or very dissatisfied with how their system worked. Thirty-eight percent said they were satisfied.
When the researchers correlated their survey results with how physicians performed on elements of the Maslach Burnout Inventory a long recognized assessment tool they found a link between the use of electronic health records and burnout, with computer ordering likely to be “the driving factor.” That spells constant frustration for busy physicians trying to schedule exams, tests and procedures before moving on to the next patient.
“Physicians using had an approximately 30 percent higher risk of burnout after adjusting for all other factors,” the researchers found.
Fixing these systems won’t be easy. They are complex, designed to satisfy a host of regulations and other requirements for billing, documentation and confidentiality.
“It is a stubborn problem, and a lot of people point fingers at each other over who owns what part of it,” Shanafelt says. “The question is how to help physicians deal with the clerical burden created by these new electronic tools.”
Date: September 08, 2016