Nearly all physicians agree that using EMRs isn’t great for their relationship with patients. But, hospital-based and office-based physicians seem to have different reactions to the problem. (Neither group is happy with their lot, but I’m sure you already guessed that much.)
The study, by researchers at Brown University and Healthcentric Advisors, is based on the open-ended answers provided by 744 doctors to a survey question: “How does using an EHR affect her interaction with patients?” (The question was posed by the Rhode Island Department of Health in 2014.)
In analyzing the responses, researchers found that office-based physicians and hospital-based physicians had different concerns about patients care and EMR use.
Office-based physicians, who typically bring their computer into the exam room, worry that staring at a computer screen will undermine the quality of their visit with the patient. “[It’s] like having someone at the dinner table texting rather than paying attention,” one doctor wrote.
Hospital-based physicians, for their part, usually do their record-keeping on EMRs based outside the exam room. They said that record-keeping took up too much time, leaving little for direct contact with patients. Said one physician: “I now spend much less time [with] patients because I know I have hours of data entry to complete.”
To maintain their standards of patient care, physicians are doing the data entry at home rather than at work, sometimes many hours at a time. Others are taking CME classes which promise to help them integrate EMR use with patient consults in the least disruptive manner. But nobody had found any good solutions to the patient care conundrum.
Of course, we knew most of this already. This study just offers some added color to a picture we’ve already seen. Both patients and physicians are suffering under current models of EMR use, and there’s little relief on the horizon.
Yes, a few physicians said that EMRs hadn’t impacted their time with patients. This might’ve been encouraging, but this group included one physician who treated newborns and another using a scribe to handle data entry during consults.
And there were a few respondents that cited positive aspects of EMR use in patient care. For example, one hospital-based doctor noted that EMRs offered him an easy way to look at a comprehensive patient history. Some office-based physicians noted that web-based patient portals were improving their patient interactions.
But the striking thing here is that few if any physicians suggested that EMRs offered any ongoing clinical benefits. As researchers have discovered many times over, most doctors saw their EMR use as a work requirement rather than a clinical exercise. This only underscores that as they presently work, EMRs benefit administrators, not care providers.
I wish I was so smart that I’d come up with some sort of solution to this problem. I haven’t. But it doesn’t hurt to harp on the existence of the problem. We should remind ourselves over and over again that it’s time to roll out EMRs that support clinicians.