Two new academic papers raise fresh questions about physician burnout and patient safety risks associated with electronic health records.
One, a study in the Journal of Graduate Medical Education, found that first-year residents in internal medicine spent 5-7 hours a day — about 40 minutes per patient — reading and entering data into EHRs. The time dwindles as they get more proficient, but it’s still a major portion of the work day.
The investigators, including students, residents, faculty and IT professionals at New York Methodist Hospital/Weill Cornell Medical College and at St. Georges University School of Medicine in the island nation of Grenada, wrote:
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“While electronic records are easier to read, significantly more time is spent on the EHR compared with paper charts. Recent studies have found that physicians spend more time on electronic documentation than providing direct patient care, and other studies have reported that clinical computer work constitutes the highest proportion of time spent by physicians.”
While they didn’t discuss the issue of EHRs compromising patient safety, Dr. Mark Friedberg of Rand Corp. did. Writing on the Agency for Healthcare Research and Quality’s Patient Safety Network journal-style forum, took a look at how physician professional dissatisfaction can be a safety risk.
Citing a 2013 study Rand conducted with the American Medical Association, Friedberg noted:
In both qualitative and quantitative analyses, we found many specific factors contributing to physician professional dissatisfaction that will probably sound familiar to patient safety experts. These included clinic leaders who ignored physicians’ ideas for improving patient care, payers that refused to cover necessary services, practice models that did not foster collegiality with other care providers, schedules that prevented physicians from spending enough time with each patient and mandated activities that physicians perceived as distractions from patient care. Physicians also reported frustrations with certain aspects of electronic health records that can undermine patient safety: crowded and poorly designed user interfaces, lack of health information exchange, and degradation of the quality of clinical documentation (including the proliferation of information that physicians do not trust).
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He recommended that executives at hospitals and healthcare systems pay attention to complaints about EHR usability. “[T]he best leaders will avoid the temptation to dismiss physician reports as whining or to apply quick but ineffective fixes. Instead, as with other indicators of threats to quality and safety, the best responses to physicians’ perceptions of these problems will be to seek corroborating evidence, assess the magnitude of threat, carefully design and implement solutions and check to make sure the solutions worked—ideally with the same physicians who reported the original problem,” Friedberg wrote.
Photo: Flickr user Juhan Sonin
