A recent survey of primary and specialty care physicians by Deloitte reveals that physician feedback on how to improve electronic health records (EHRs) is often overlooked as physicians continue to be frustrated with EHRs, particularly due to lack of interoperability and the burden of documentation.
Deloitte recently released a report about physician interaction with EHR technology based on the Deloitte 2018 Survey of U.S. Physicians, a survey of 624 U.S. primary care and specialty physicians.
With regard to EHR technology, the survey results suggest that at best, physicians perceive themselves as passive participants in EHR optimization efforts and, at worst, they feel ignored. Just one-third of physicians surveyed (34 percent) say their organization or EHR vendor sought their feedback on EHR enhancements; and this proportion is about the same for employed or affiliated physicians vs. independents. Primary care physicians are an exception: forty-four percent of them have been asked for feedback.
The survey results also point to a link between inviting feedback and sustaining engagement—half (51 percent) of physicians who were not asked for feedback say they are unaware of EHR optimization efforts within their organization or through their EHR vendor, but only 16 percent of physicians invited to provide feedback say so, the survey found.
The survey results indicate that lack of interoperability and ease of use continue to be big pain points with EHR systems. When asked what changes they would make to their current EHR system, 62 percent of respondents cited “making the current system more interoperable” and 58 percent would like to improve their EHR’s capability to easily add patient visit information.
What’s more, 39 percent of physicians want their EHR to be seamlessly available and accessible by mobile devices, 38 percent want their EHR to better support workflow management across the continuum of care and 37 percent see an opportunity to automate reporting to meet quality reporting requirements. Another 37 percent of respondents want EHR vendors to improve the capability to generate custom reports on their patient populations. Only 10 percent of physicians said they were satisfied with their EHR “as is.”
Documentation is the number one area where physicians see opportunities for efficiencies, according to the survey. Physicians also cited communication and care coordination (20 percent) as another area that could be completed more efficiently. Based on the responses, specific documentation tasks that could be done more efficiently include charting, capturing visit notes, data entry, and inputting boilerplate information to meet administrative requirements.
“The frequency and context of the mention of dictation tools in the survey responses suggest that physicians either underutilize them or find them subpar. Prior to the advent of EHRs, dictation was a common way to record notes. Though early generations of EHRs did not have the capability to convert dictated notes into structured information, the technology has evolved and new tools are becoming available to codify typed or dictated text,” the survey report authors wrote.
The survey report also notes that many healthcare organizations are experimenting with natural language processing (NPL) to unlock critical information from narrative reports, such as progress notes, discharge summaries and radiology and pathology reports to support patient care, administrative requirements and research. “Today, NLP technology is either expensive or requires considerable computer science expertise. As off-the-shelf NLP software becomes more accessible, organizations may discover additional documentation-related uses. Other technologies, such as artificial intelligence, robotic process automation, and blockchain, may support revenue cycle management activities that rely on EHR inputs,” the report authors wrote.
On the issue of interoperability, the report notes that organizations often face interoperability-related challenges at multiple level. As health systems have grown through mergers and acquisitions, different parts of the organization may be on different EHR systems. What’s more, multiple other information systems and clinical equipment may need to be connected to contribute to and/or extract data from EHRs. And as the number of connected devices grows, so does the need to ensure data security without inhibiting user experience.
Market dynamics, such as the Fast Healthcare Interoperability Resources (FHIR) standard, are helping to spur interoperability, however, solving the interoperability challenge can require multiple external and internal parties to collaborate and agree on common standards and governance, the report authors wrote.
“At a minimum, health systems and EHR vendors can share updates with their EHR users about important interoperability milestones achieved or functionalities added. Any interoperability improvement could support physicians in delivering care more efficiently,” the report authors wrote.
Survey respondents were asked what kind of EHR enhancements are underway at their organization or their EHR vendor. Fifty-six percent cited “improve/add capability to more easily input information about a patient visit” and 52 percent said current enhancement efforts are focused on making the current system more interoperable. Forty-three percent said enhancement efforts are focused on making the EHR seamlessly available and accessible by mobile devices and 41 percent said their organization and/or EHR vendor is working to improve the capability to generate custom reports on physicians’ patient population. Forty-percent of respondents said their organizations are working to automate reporting to meet quality reporting requirements to various payers and 37 percent said efforts are focused on better supporting workflow management across the care continuum.
Interestingly, as noted above, physicians who were not asked for feedback on EHR enhancements were less aware of those enhancement efforts. For instance, 17 percent of respondents who had not been asked for their feedback said their organizations were currently working to make their EHR systems more interoperable, while more than double (39 percent) of physicians who had been asked for their feedback were aware of interoperability enhancement efforts underway at their organizations.
The report also recommends a number of steps that healthcare organizations leader can take to improve clinicians’ experience with EHRs.
- Proactively seek physician feedback. Direct feedback combined with other data can help the informatics team understand the goal of an optimization request and identify the best method to achieve that goal.
- Optimize workflow. When using an EHR, how one team member uses it can affect how others do their work. Organizations may realize that a solution to a problem may not always involve changing the system but rather ensuring that all users adhere to the correct and standard workflow.
- Communicate progress. Fully addressing certain EHR issues (such as interoperability) may be a lengthy process. Communicating the progress and attainment of interim goals can signal continued commitment to resolving the issues that vex users.
- Stay abreast of new technology and the vendor landscape. Many emerging technologies are in the early stages of development, but the landscape is changing, with some technologies and use cases quickly approaching maturity.