Are EMRs Getting Worse Or Doctors Getting Smarter?

I know it sounds crazy — it’s hard to imagine doctors being more annoyed with EMRs than they already are — but according to one study that’s just what’s happening.

A newly-published study by the American Medical Association and the American College of Physicians’ AmericanEHR division suggests that doctors like the current crop of EMRs less than ever.

About half of study respondents said that their EMR was having a negative impact on costs, efficiency or productivity, the groups reported. Only 22% said they were satisfied with their EMR, and a scant 12% said they were “very satisfied.”

Doctors’ happiness with their EMRs has dropped substantially since five years ago, when 39% reported being satisfied and 22% said they were very satisfied, according to a prior study by AmericanEHR.  In other words, nearly 4 out of 10 doctors surveyed seem to have been content with what they had. But conditions have clearly changed.

The reasons for this are unlikely to be the result of mere peevishness. After all, with EMRs being a reality of doing business today, it seems unlikely that physicians would simply revert into sulking. Actually, my own unofficial survey — of several docs I’ve actually seen as a patient — suggests that most have gone through their stages of grief and decided that EMRs aren’t unholy. (My PCP said it best: “You get used to them, then they’re not so bad.”)

Instead, I’d argue, something good is actually happening, though it may not look that way on the surface. Having adapted to the need to use EMRs, physicians are engaging with them deeply, and beginning to expect more from them than a kludgy interface slapped on a slow database can provide.

Some are actually proposing that EMRs go beyond traditional medical record paradigm, something I see as an exciting development. For example, Dr. Arlen Meyers, CEO of the Society of Physician Entrepreneurs, argues that it’s time to “unbundle and re-engineer the care processes model” by introducing new templates into EMRs. In fact, he’s a fan of rethinking the hallowed SOAP (symptoms, objective findings, assessment and plan) approach to patient notes:

Given how things are changing, it might be time to give the pink slip to SOAP. The main problems are that 1) the model does not prioritize information by levels of urgency, 2) it does not provide decision support when it comes to how one disease affects the other or how one medicine affects another, and 3) it does not add efficiencies to taking care of increasingly complex patients.

And Meyers is not the only one. In fact, a recent paper published in JAMA Internal Medicine suggests that a new format flipping the elements of the SOAP note and reordering them as APSO (assessment, plan, subjective, objective) works well in the EMR age.

According to a 2010 study detailed in the paper, APSO notes were fairly successful at the University of Colorado ambulatory clinics. The study, which looked at APSO use in 13 clinics, found that 73% of participants were “satisfied” or “very satisfied” with the new format, and 75% “preferred” or “strongly preferred” reading APSO notes.

I’m betting that physicians will only be satisfied with EMRs again when EMRs are reshaped to embrace new ways of working. Since new workflow demands are generated by using EMRs, in turn, this cycle may never end. But that’s a good thing. If physicians are engaged enough with their EMRs to propose new ways of working, it will benefit everyone.

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.


  • I’m pretty surprised this article touched on physician satisfaction with EMRs and the changes in the last 5 years without referencing Meaningful Use. EMR adoption has also changed a lot in the last 5 years, with many practices (for better or worse — mostly worse) adopting on the basis of capturing incentive payments. Add increased adoption to some of the more ridiculous product-certification requirements of Meaningful Use, and you have not only a lot of wasted time (that could have been spent by EHR providers on technical innovation), but the perfect recipe for lots of unsatisfied users, not just physicians.

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