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Physician Survey: EHRs Increase Practice Costs, Reduce Productivity

October 3, 2016
by Heather Landi
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Three out of four physicians believe electronic health records (EHRs) increase practice costs, outweighing any efficiency savings, and seven out of 10 think EHRs reduce their productivity, according to a Deloitte’s recent 2016 Survey of U.S. Physicians.

The survey findings indicate that the majority of physicians hold negative perspectives on some aspects of EHRs, similar to a 2014 survey of physicians by Deloitte. However, the survey also found that physicians believe that EHRs are most useful for analytics and reporting capabilities compared to other attributes, such as supporting value-based care or improvements to clinical outcomes.

Researchers at the Deloitte Center for Health Solutions surveyed 600 primary care and specialty physicians on their attitudes and perceptions on a range of topics on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), value-based payment models, consolidation, and health information technology (HIT).

The survey findings about physician perceptions of EHRs and productivity mirrors a recent study published in the Annals of Internal Medicine that found during office hours physicians spent nearly 50 percent of their time on EHR tasks and desk work. For that study, researchers concluded that for every hour physicians provide direct clinical face time to patients, nearly two additional hours is spent on EHR and desk work within the clinic day, And, outside office hours, physicians spend another one to two hours of personal time each night doing additional computer and other clerical work.

The results of the Deloitte survey found that physicians' perception about whether EHR capabilities support clinical outcomes has not improved since the 2014 survey. Specifically, less than half of physicians (47 percent) surveyed in 2016 agree that EHR capabilities improve clinical outcomes versus slightly more than half (55 percent) of physician respondents in 2014.

In a blog post, Mitch Morris, M.D., global life sciences and healthcare industry leader, Deloitte Consulting, wrote that back in 1990 he became aware of the potential of EHRs to improve efficiency, effectiveness, quality and safety. “Now, more than 25 years later, we still have challenges in delivering true value to clinicians and patients. Sure, we have made great progress. But, as an industry we still seem far from the goal line.”

The survey also found that physicians believe that EHRs are most useful for analytics and reporting capabilities (78 percent) compared to other attributes, such as supporting value-based care or improvements to clinical outcomes. And, that perception increased since the 2014 survey, when 68 percent of physicians said EHRs are useful for analytics and reporting.

In his blog post, Morris wrote that the survey doesn’t signify that the Health Information Technology for Economic and Clinical Health (HITECH) Act’s Meaningful Use Program – which gave bonuses to clinicians who adopted certified EHR systems – has been unsuccessful, but the survey findings indicate there is room for improvement from the physicians’ perspective.

Almost two-thirds of physicians (62 percent) want EHRs to be more interoperable and 57 percent want improved workflow and increased productivity, with 12 percent of physician respondents stating that they do not want improvements to their current system.

“These last points will likely be critical as we enter into the first phase of implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA),” Morris wrote. “EHRs and interoperability are a fundamental aspect of virtually every part of this initiative. For example, while Meaningful Use will be phased out for eligible professionals, the US Centers for Medicare and Medicaid Services (CMS) has replaced it with the Advancing Care Information measure under the new Merit-Based Incentive Payment System (MIPS). MIPS is for clinicians who do not meet the Advanced Alternative Payment Model (APMs) thresholds. For most of the categories under MIPS, clinicians will be able to report using their EHR, too. Clinicians in Advanced APMs will not be able to avoid it either – only payment models that use certified EHR technology will qualify under the Advanced APM definition.”

The survey findings also indicate that few physicians would stop using their current EHR system, as three out of five said they would keep the current EHR system they have and not replace it.

The results of the survey also indicates that physician satisfaction with EHRs varies by practice characteristics. Employed physicians, compared to independent physicians, are more likely to think that EHRs support the exchange of clinical information (70 percent compared to 50 percent) and help improve clinical outcomes (61 percent compared to 40 percent).

Independent physicians are more likely to think that EHRs reduce productivity (72 percent) compared to employed physicians (57 percent). Additionally, 80 percent of independent physicians think that EHRs increase practice costs, compared to 63 percent of employed physicians.

“Not unlike the practice of medicine itself, effective implementation of EHRs can be part science and a healthy dose of art,” Morris wrote. “The art of the EHR includes our ability to manage change, train clinicians in a holistic way, transform workflow, and truly take advantage of automation. We may get there but, we should consider being responsive to the strong notes of concern from the clinical community.”

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