Doc dissatisfaction with EHRs grows: survey

March 06, 2013
by Brendon Nafziger, DOTmed News Associate Editor
Doctor satisfaction with electronic health records has dropped and nearly one-third report they have never regained productivity lost after setting up the electronic systems, according to a new survey that paints a mixed picture of the technology.

At HIMSS' annual meeting in New Orleans on Tuesday, the American College of Physicians and American EHR Partners unveiled the results of an ongoing survey that found physician frustrations with EHRs grew somewhat along a range of measures, from ease of use to the ability to lighten workloads.

"Multiple factors are influencing the reduction in satisfaction levels," Dr. Alan Brookstone, the study's co-author, told DOTmed News. "I think the usability of the product is not keeping up with the needs of the users."

The 155-question survey was conducted with 10 professional societies and ran from March 2010 through December 2012, polling some 4,200 physicians to see how they felt about their certified EHRs' abilities to make them more productive or reach meaningful use objectives.

The researchers found over the past two years a slight case of diminishing returns. Compared with respondents in 2010, a greater proportion of doctors in 2012 were less satisfied with their software. This applied across specialties and vendors, the survey said.

In 2012, about one-third were "very dissatisfied" with the ability of their EHR to decrease workloads, up from only one-fifth in 2010, according to the survey. Gripes were seen elsewhere, too. Thirty-two percent were dissatisfied with EHR features and functionality in 2012, compared with 20 percent in 2010, while 37 percent in 2012 were not pleased with their product's ease of use, up from 23 percent in 2010. One-fifth were also highly displeased with the technology's ability to improve patient care last year, compared with one-tenth in 2010.

Most tellingly, perhaps, 38 percent of respondents in 2012 said they wouldn't repurchase their EHR again. In 2010, only one-quarter had this sentiment.

Also of note was how long it took practices to return to the same level of productivity they enjoyed prior to installing the EHR. About one-third returned to normal in less than three months, and another third at three months or later. But 32 percent of respondents said they had not yet returned to their initial productivity levels.

"That was a really unsettling finding," Brookstone said.

Why the change?

Why exactly were the doctors more displeased now than in 2010? Brookstone said they first thought it was a population effect. New users, prompted perhaps by meaningful use incentives, acquired EHRs and were experiencing growing pains. But he said that's not the case. The average length of use for all users of the three-year period was nearly the same in 2010, 2011 and 2012, he said, with most having used EHRs for at least three years

Instead, what might be happening is the systems aren't "optimized" for specialty users, who in the survey were less satisfied than primary care practices, Brookstone said. For instance, close to half of primary care docs said they were either "satisfied" or "very satisfied" with their EHRs' ability to improve care, as opposed to only one-third of surgical specialty practitioners.

Training is also an issue. To get the most out of advanced functions, the survey suggests user satisfaction peaks with one week of training; for more basic ones, at three to five days, Brookstone said. But in the survey, about half of respondents said they had fewer than three days of training, or none at all, Brookstone said.

The big concern with this is that doctors will likely face more complexity when later meaningful use stages take effect. In a January letter to Farzad Mostashari, the National Coordinator for Health Information Technology, ACP worried that the to-be-decided Stage 3 looks to focus on functional measures rather than patient outcomes and will increase documentation — all of which could dampen physician participation or satisfaction.

"What's concerning [in] some of the trends: we're not achieving, at least by these data, the uptake in use we hope to achieve," Dr. Michael Barr, the survey's co-author, told DOTmed News.

The survey also comes as other red flags have been raised about computer health systems. On Monday, a Health Affairs report that found many practices lost money investing in EHRs, even with the $44,000 meaningful use incentive offered by the Centers for Medicare and Medicaid Services.

For now, the researchers said they're undertaking a more detailed analysis, which they hope to have wrapped up in the next four to six weeks.

"We're supportive of meaningful use," Barr said. "We're concerned about the pace."