Maintaining a record of patients’ medical charts required a lot of physical labour before electronic medical/health records (EMRs/EHRs) became a routine.  This physical work provided a greater chance of human error and overlooked information and eventually, irregular maintenance of records. There was a fair chance of 5 out of 15 charts for a clinic day to be unavailable at any given time, which ultimately led to wasted time, space, motion and frequent defects to care. (1)

Electronic medical records, in contrast, have eliminated the manual labour in maintaining patient charts, thus making data available at all times. Moreover, clinicians can remotely access patient files in a secure way. This also reduces the storage and inventory, thereby freeing up physical space within the hospital or office, allowing the relocation of human resources. This ultimately eliminates unnecessary movement and batch delivery in order to improve the flow of patients and information. As a consequence, all of this leads to the reduction in waste as well as improved quality of care for the patient. (1)

However, even though EMRs are a part of nearly all physician practices in the west, implementing them has been quite challenging. In a recent report on EMR use, Medscape surveyed 15,285 US physicians across over 25 specialties, asking them questions about usage, specific system ratings, and vendor satisfaction. (2) Physicians elaborated on the impact of EMRs on practice operations and patient encounters. Largely, physicians opined that they faced a challenge with more screen time and less direct clinical face time with patients. Almost half of the respondents did not believe that EHRs improved documentation or for that matter, anything else at all. (3,4)

Another survey by The Doctors Company in more than 3,400 US physicians found EMR systems to be falling short of provider expectations, reducing the joys of practicing medicine. Majority of these physicians reported EMR systems to have negatively impacted on the patient-provider relationship, clinical workflows, and clinical productivity. Sixty-one percent of physicians reported that value-based care and reimbursement would negatively impact their practice; while 63 percent of respondents opined it would negatively affect their earnings. (5) This general dissatisfaction among physicians with EMRs and value-based care resonates with the findings of a recent JAMIA study, which assessed provider satisfaction through 4 survey rounds during the phased implementation of EMRs. Findings from this study showed that provider dissatisfaction with EMRs and difficulties incorporating EMR technology into patient care may negatively impact patient satisfaction. (6)

While EMRs have ample benefits, such as better accessibility to patient data, increased charge capture and enhanced preventative health, the inherent problems in embracing this technology cannot be overlooked. If an EMR is not supported with well-thought processes, hospitals may invest in complicated and expensive technologies that create more waste in a system already troubled with ineffectiveness. Implementation of EMRs may contribute to several disadvantages, such as lack of interoperability between technologies; increased costs of setting up as well as maintenance; drop in physician productivity; delays in documentation; constant need for updates and lack of accountability for doing so; and so on. Extensive use of EMRs can also lead to privacy violations. In addition, auto-population of data for new records can also result in inaccurate new records along with other technological errors. (1)

Having said that, while advantages of EMRs to the physician, hospital or physicians’ office and patient alike are considerable, their disadvantages can often prevail over their benefits. To avoid these issues and curb the possible errors, hospitals and healthcare systems must perform a thorough evaluation of the EMR system before purchase and implementation. (1)

References

  1. Palma G. Electronic Health Records: The good, the Bad and the Ugly. October, 2013.
  2. Peckham C, Kane L. Medscape EHR report 2016: Physicians rate top EHRs. Medscape Business of Medicine. August, 2016.
  3. Selanikio J. Physician Satisfaction with EHRs: It’s Even Worse Than You Think. January, 2017.
  4. Sinsky C, Colligan L, Li L, et al. Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties. Ann Intern Med 2016; 165(11):753-760.
  5. Monica K. 61% of Physicians Say EHR Systems Reduce Clinical Efficiency. October, 2018.
  6. Meyerhoefer C, Sherer S, Deily M, et al. Provider and patient satisfaction with the integration of ambulatory and hospital EHR systems. J Am Med Inform Assoc 2018; 25(8):1054-1063.

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