Almost Half of Physicians Say EHRs Have Hurt Quality of Care

Marcia Frellick

May 01, 2019

In a Medscape poll of more than 250 clinicians, 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.

The recent poll included 273 respondents — 207 physicians and 66 nurses/APRNs.

Few Involved In Choosing EHR System

The poll also indicated that few physicians or nurses were involved in the decision of which EHR to use in their primary workplace.

Among physicians, 66% had no input, 28% had input, and 7% did not use an EHR system (rounding means totals may pass 100%). Far fewer nurses were part of the decision making: 80% had no input, 18% had input, and 2% did not use an EHR.

Only 2% of physicians, nurses, and APRNs said they had input into the decision and the system they wanted was chosen.

Those who answered that they had input were either the only decision-makers or were part of a group that decided. Those who did not have input answered that the practice, clinic, or hospital chose the system or a group or committee leader chose it.

Views on How EHRs Increase/Decrease Quality

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 neurosurgeon commented on the poll, "I'm surprised that the tendency to rely on default, boilerplate text and copy-paste were not noted as major problems."

Most Requested Improvements

Top answers differed among physicians and nurses/APRNs on what they would most like to see change with EHRs.

Physicians' top answer was to make the systems more intuitive/user-friendly (44%), followed by allowing greater interoperability and record sharing (30%). Nurses/APRNs would most like to see more interoperability and better record sharing (33%), followed by making the systems more user-friendly (30%).

This past February marked 10 years since the American Recovery and Reinvestment Act devoted $35 billion to encourage physicians to use EHR systems.

"Boring, Repetitious Templates"

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.

Medscape reported earlier this month that the drift from face-to-face care is continuing with the next generation of physicians.

Results from the iCOMPARE trial show that 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.

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