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September 27, 2018

The future of EHRs, charted

Daily Briefing
    A new paper from Stanford Medicine spotlights what primary care providers want from EHRs.

    For the paper, Stanford surveyed more than 500 primary care physicians on what they think the future of EHRs should look like. The survey was conducted alongside Harris Poll and aimed to determine how to "transform EHRs from an administrative burden into a useful sidekick."

    Why the EHR life cycle is just like raising a child

    EHRs are remarkably time-consuming

    One finding that we've heard before: Respondents to the poll said they're spending a significant amount of their patient visits entering information into EHRs. Overall, doctors said they spent more than 60% of their patient-focused time interacting with EHRs. They reported an average of:

    The researchers also found:

    • 74% of respondents agreed that using an EHR increased the total number of hours they worked daily;
    • 71% of respondents agreed that EHRs contributed significantly to physician burnout;
    • 69% of respondents agreed that using an EHR takes valuable time away from patients; and
    • 49% of respondents agreed that using an EHR detracted from their clinical effectiveness.

    That said, some PCPs said EHRs benefited their patient relationships. According to the survey, 31% of respondents felt their EHR had strengthened their patient relationships.

    Making EHRs less frustrating

    Using medical assistants as "digital scribes" can help alleviate some of the time and burnout associated with EHRs, according to work by researchers at University of Colorado Health, which saw a decrease in burnout over the course of a year after hiring more medical assistants (MAs). University of Colorado Health increased the ratio of MAs to physicians to about two to one, up from 0.4 to one. MAs spend about 20 minutes with patients, during which they update records and address minor medical tasks, such as administering vaccines. The university found the effort "went a long way to relieving physician burnout," according to the Stanford paper.

    EHRs have potential to be a useful clinical tool, but they're not there yet

    While many Stanford poll respondents said EHRs could—and should—be a useful clinical tool, few physicians said the systems provided clinical value. Just 8% of respondents said factors related to disease prevention and management, clinical decision support, and patient engagement were the primary value of their current EHRs. Meanwhile, 44% of physicians said the primary value of EHRs was to serve as a form of digital storage.

    However, respondents noted that EHRs could become more clinically useful with the advent of AI capabilities, which could quickly scan patients' medical records and offer real-time clinical recommendations to doctors based on that information.

    How do physicians want EHRs to change?

    Physicians responding to the Stanford poll named long- and short-term developments they'd like to see among EHRs. About two-thirds of physicians said interoperability was the long-term fix they'd most like to see when it comes to EHRs.

    Interoperability is a frequently-cited problem with EHRs. While EHRs could improve information sharing among multiple hospitals and offices, they often fail to communicate effectively with other systems. A survey published in JAMIA in July of 63 pairs of hospitals that frequently shared patients found that nearly a quarter reported information sharing became worse after adopting EHRs.

    As for short-term fixes, almost three-quarters of physicians said they'd like to see the EHR user interface improved to eliminate inefficiencies.

    How medical practices, payers, and regulators can make EHRs better for doctors

    The researchers concluded the paper by summarizing a number of actions different stakeholders could take to improve EHRs going forward.

    Actions medical practices can take include:

    • Investing in EHR training when new physicians start and when changes are made to the EHR system;
    • Seeking physician input on prioritizing EHR development tasks and developing clinical workflows that leverage EHR potential;
    • Drafting EHR governance that allows the organization to be nimble when responding to crisis;
    • Making analytics data accessible to physicians;
    • Delegating non-essential data entry to ancillary staff;
    • Reevaluating how the organization interprets privacy rules;
    • Getting rid of the fax machine;
    • Creating opportunities for patients to maintain their records digitally; and
    • Accepting electronic payments.

    Actions payers can take include:

    • Committing to and supporting value-based care, despite EHRs currently reflecting fee-for-service models;
    • Developing common billing and quality reporting standards across payers;
    • Streamlining prior authorization;
    • Allowing physicians to access claims more easily, so physicians can get a better long-term understand of their patients' health.

    Actions regulators can take include:

    • Affirming commitment to value-based care and moving away from literal documentation for doctor-patient interactions;
    • Creating more flexibility for EHR data entry to allow people other than highly trained clinicians to handle this task; and
    • Clarifying information-blocking rules and removing incentives to hoard information (Kim Cohen, Becker's Hospital Review, 9/19; Stanford Medicine white paper, accessed 9/26; Stanford Medicine survey; accessed 9/26).

    Cheat sheets: Understand interoperability, EHR optimization, and more

    Download our cheat sheets so you can keep track of the fast-changing technologies and capitalize on opportunities for IT-powered innovation. Check out our guides for these topics and more:

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