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One Medical Researcher’s Take on EHR Usability and the Impact on Patient Care

July 11, 2017
by Heather Landi
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While it’s no secret that physicians have complaints about electronic health records (EHRs), the co-author of a new medical study about hospital-based physicians’ perceptions of EHRs says the study findings illustrate that EHR usability should be addressed as a quality of care issue.

As reported by Healthcare Informatics, an analysis by researchers at Brown University and Healthcentric Advisors, and recently published in the Journal of Innovation in Health Informatics, found that hospital-based physicians and office-based physicians generally perceive EHRs, in their current design, negatively altering patient interactions, however, hospital-based physicians cited different reasons than their office-based counterparts. Hospital-based physicians commented most frequently that using EHRs takes time away from patient contact; office-based physicians commented on EHRs worsening the quality of their patient interactions and relationships.

The analysis is based on the open-ended answers that 744 doctors gave to this question on a Rhode Island Department of Health survey in 2014 on health information technology: “How does using an EHR affect your interaction with patients?”

According to the study, one hospital-based physician commented, “We spend less time at bedside and more time interacting with our computers.” The study found that the second most common theme among hospital-based physicians was the negative impact of EHRs on the quality of interactions with patients and therefore physicians’ relationships with patients. One hospital-based respondent commented, “My nose is now burrowed deep into my computer interface, leaving markedly reduced time to make eye contact and actually interact one on one with my patient.” The study also found that hospital-based physicians report benefits from using EHRs, ranging from better information access to improved patient education and communication.

The study authors contend that this particular analysis is novel for its relatively large sample size and its incorporation of both hospital and office-based physicians. And, the findings add to the prior literature, which focuses on outpatient physicians, and can be used to shape interventions to improve how EHRs are used in inpatient settings, the study authors stated.

The study was led by Rebekah Gardner, M.D., an associate professor of medicine at the Warren Alpert Medical School of Brown University and a senior medical scientist with Healthcentric Advisors; Kimberly Pelland of Healthcentric Advisors and Rosa Baier, associate director of the Center for Long-Term Care Quality and Innovation and an associate professor of the practice at the Brown University School of Public Health.

Healthcare Informatics Associate Editor Heather Landi recently spoke with Gardner about the implications of the study findings, the issue of EHR software usability and the potential impact on quality of care.

What motivated you and your fellow researchers to examine this issue of EHRs and the impact on physician-patient interaction in hospitals?

The Rhode Island Department of Health has been administrating this health IT survey since 2008, and every year there’s a box at the end that says, ‘If you have any additional comments, please leave them here.” It’s a standard survey box, and we were struck by the anguish that came through in the comments that people chose to leave and we really noticed quite a common theme where people said, ‘We get it, EHRs aren’t going away and they do add value, but here are the things that really make it so hard for us.’ After reading these comments year after year, we thought we needed to get at this in a more scientific way. So, we specifically included a question about the patient interactions and devoted time to doing an actual qualitative analysis, which is different than reading through comments and getting a general sense. In 2014, we invented that particular question [used in the study] and we wanted to take a more scientific approach to echo what we had been hearing for years, but hadn’t really fully captured by the usual use of multiple choice questions.

What is unique about this study compared to previous research about physicians’ use of EHRs?

Most of the research has been done in the office-setting, mostly around primary care physicians and family physicians. Those physicians are all unified in way because there is a commonality across the doctors who see the same patients time and time again; they have a longitudinal relationship with patients. They are usually using a computer in the exams room. That’s a particular type of doctor-patient relationship, and a particular use of the computer. We really noticed an absence in the literature of inpatient physicians. I practice medicine, personally, both in the office and in the hospital and reflecting on that, the way we use the computer in the hospital is quite different. Usually the computer is outside the exam room; we go in and have a conversation with the patient that we’re meeting for the first time that day and may never see again. Then, I go and document later in the chart without the patient being there. The way the computer is part of the physicians’ day is quite different and the relationship between the patient and the physician is quite different. We wanted to get a sense of whether the computer is even an issue, honestly, for inpatient doctors, and it turns out, it was.

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