A newly published survey of 1,200 physicians nationwide by the Watertown, Mass.-based athenahealth, which specializes in providing cloud-based based services for electronic health record (EHR), practice management, and care coordination, is revealing a mixed bag of opinions among doctors regarding how well electronic health records (EHRs) are working for them, with a range of views about the efficacy, cost-benefit analysis, and usability, of EHRs. Meanwhile, attitudes towards government involvement in healthcare have become more positive in the past year. But there remains concern over the transition to the ICD-10 coding system.

The survey, whose results were made public on Aug. 12, found that, while a majority have a favorable opinion of EHRs, a majority also believe that the benefits of EHR implementation do not outweigh their costs, a finding that should cause healthcare IT leaders nationwide to pause.

For example, while 31 percent of survey respondents have a “very favorable” opinion of EHRs, 38 percent have a “somewhat favorable” opinion, and 14 percent have a neutral opinion, of them, and only 18 percent have unfavorable views (virtually unchanged from 2012), and 68 percent believe that EHRs improve patient care quality, only 49 percent believe that the financial benefits of implementing EHRs outweigh the costs, while 51 percent say they do not (compared with 53 percent who said they outweigh the costs last year, with 47 percent saying last year that they do not outweigh the costs).

Perhaps an even more troublesome finding from the survey is that, just as they said so in 2012, a significant plurality of physicians in practice agree that EHRs were not designed with physicians in mind. Here is how the responses to that question break down: 4 percent strongly agree that EHRs were designed with physicians in mind, while 25 percent agree, and 25 percent neither agree nor disagree. But fully 29 percent disagree, and 18 percent strongly disagree; in other words, 47 percent of physicians believe that EHRs were not designed with doctors in mind, a result that should concern CIOs, CMIOs, and other healthcare IT leaders in medical groups, hospitals, and integrated health systems. With regard to specific EHR solutions, slightly more physicians said their views of those solutions were “neutral” versus “somewhat positive,” as they had in 2012.

One very bright spot in the survey’s results related to reimbursement processes: significantly fewer physicians in 2013 said that “getting paid has become more of a burden and complex.” In 2012, 57 strongly agreed with that sentiment, with regard to getting paid by private insurers, while that percentage dropped to 41 percent this year; with regard to Medicare, that percentage feell from 47 to 33 percent; and with regard to Medicaid, it fell from 50 to 35 percent. Oddly enough, there was a significant decrease in physicians reporting that they are participating in some sort of pay-for-performance program, a result that may require future clarification.

When it comes to broader healthcare policy issues, there remains widespread skepticism among practicing physicians about the federal government’s ability to improve outcomes aor lower costs through regulatory involvement. In response to the statement, “More active government involvement in healthcare regulation can lower costs,” 6 percent strongly agreed, 32 percent agreed, 18 percent neither agreed nor disagreed, 24 percent disagreed, and 31 percent strongly disagreed. Asked the same question regarding the government’s regulatory involvement improving care quality outcomes, 5 percent strongly agreed, 29 percent agreed, 24 percent were neutral, 28 percent disagreed, and 25 percent strongly disagreed. Still, it is worth noting that the percent of those agreeing or strongly agreeing that the government could help lower costs through regulation rose from 25 percent in 2012 to 38 percent in 2013; and the percent agreeing that government regulatory involvement could improve care quality outcomes rose from 20 percent in 2012 to 35 percent in 2013, a very significant increase. Still, more than 60 percent of those surveyed believe the current healthcare climate is detrimental to care, a consistent finding over the past four years of this survey.

“Doctors are besieged by change and requirements, and it’s incredibly difficult for them to keep up,” said Todd Rothenhaus, M.D., athenahealth’s CEO, in a press release statement on the results of the survey. “As an industry and country, we need to pay attention the fact that doctors are overwhelmed and challenged in areas they shouldn’t be. Physicians lack the time and, in too many cases, the resources to thrive through change. They need better support and need to know there are tools and services to remove the ‘busy’ work, so they can focus on patient care.”

In another policy-related area, only 7 percent of survey respondents said they were “very confident” that their EHR vendor would be able to successfully help them transition to the new ICD-10 system and its requirements, while 27 percent said they were “somewhat confident.” But 41 percent said they were “neutral,” 19 percent said they were “not very confident,” and 7 percent said they were “not at all confident” in their vendors’ abilities in that regard.

Most ominously, fully 78 percent of physicians in practice are not optimistic about independent and small physician groups surviving.

Physicians in practice can see the full results of the survey at www.athenahealth.com/PSI