Electronic Health Reporter

Another day, another study, but this one – about the EHR user’s satisfaction levels with their systems – seems to have some teeth. According to the survey, “EHR Satisfaction Diminishing,” which was administered by the adept AmericanEHR group, users of EHRs are becoming ever more disenfranchised with their EHRS.

According to the AmericanEHR, data was collected over a two-year period of time, from 2010 through 2012. After two years of use, and in some cases longer, practice leaders and caregivers who have time to figure out their electronic collection systems and who are past the test-drive phase say they are not happy with the technology.

I’ve made this case before, but this is one of the primary reasons I strongly recommend physicians not getting locked into extremely long-term contracts. For example, some vendors require seven years. That’s way too long. Stay away.

Nevertheless, this could just be a standard response to the technology as a whole, but let’s get to the results of the survey. For brevity’s sake, I’ve cut what I don’t find to be significant. Some of the results noted here are amazing and eye opening; you decide.

Highlights include:

• 71 percent of respondents were in practices of 10 physicians or less;
• The average length of time that survey respondents had been using their EHRs was more than three years at the time of the EHR satisfaction survey;
• Satisfaction and usability ratings are dropping. This holds true regardless of practice size, specialty type and across multiple vendors;
• Overall, EHR user satisfaction reveals a 12 percent drop in satisfied users from 2010 to 2012 and a corresponding increase in very dissatisfied users of 10 percent for the same period;
• In 2012, 39 percent of clinicians would not recommend their EHR to a colleague (I’m not surprised by this, especially given my experience with vendors);
• Average satisfaction level with the ability to improve patient care decreased from 2010  through 2012 for all specialty groups;
• Satisfaction with ease of use dropped 13 percent between 2010 and 2012 and 37 percent reported increased dissatisfaction in 2012;
• 34 percent of users in 2012 were very dissatisfied with the ability to decrease workload compared to 19 percent in 2010.
  

Why is this happening (according to AmericanEHR)? The following hypotheses may explain some of these findings:

• With Meaningful Use, users may have lost some of their workarounds or have new ones that they have to do e.g. clinical visit summary that now takes 10 clicks and as a result workflow may feel more cumbersome;
• The difference between cognitive versus procedural specialists. If one asked the majority of physicians how they would rate the quality of care they provide, most would likely say very good to excellent. Unless these physicians regularly use dashboards and reports they do not know whether they are doing better using an EHR. This is more challenging with procedural specialists such as a thoracic surgeon or orthopedic surgeon. It is not clear how the EHR helps with improving quality of care for proceduralists;
• As we have further analyzed the data in related to satisfaction with the ability to improve patient care by duration of EHR use prior to completing the EHR satisfaction survey, there appears to be a strong correlation between length of use an EHR and ability to improve patient care especially in those who have been using an EHR for 5+ years. This could suggest that there is a minimum period of time that someone has to use an EHR before beginning to demonstrate improvements in patient care;
• Dissatisfaction may also be a result of being asked to do something with an EHR that previously was not required (prior to Meaningful Use);
• There continues to be an inability to complete certain tasks electronically despite having an EHR. For example, ACOs that require a paper form to be completed for registration of each patient in a pay-for-performance program, resulting in increased workload and decreased productivity/satisfaction.
  

Additional observations (which are amazingly insightful):

• The speed of change in relation to the Meaningful Use program may be too much too fast for many practices who are unable to cope the demands and workload;
• Different populations have different expectations. The pioneers and early adopters have a greater tolerance for the problems and challenges of implementing an EHR vs. those in the mid or late majority;
• EHR systems clearly have usability issues which need to be addressed even with respect to basic functionality.
  

Recommendations (here’s the real gold):

• Training is a significant deficiency. Training is required at all stages of adoption, both at time of implementation and as more advanced functionalities are required or integrated with EHRs. Almost 50 percent of respondents in a 2011 AmericanEHR report on the correlation of training duration with EHR usability and satisfaction reported receiving less than three days of training to use their EHRs or no training at all;
• Dissatisfaction levels with basic EHR functionalities highlight the need to improve existing technologies rather than just focus on adding new features and capabilities;
• Clinician workload within the practice must be re-balanced. Providers are working harder and face numerous additional challenges including the impact of payment reform and the need to comply with multiple incentive/penalty programs.

In closing, according to AmericanEHR: “If these issues are not recognized and addressed, the alternative is that clinicians will do the bare minimum in order to meet meaningful use requirements.”