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Is Your EHR Contributing to Physician Burnout?

Posted on September 28, 2016 I Written By

The following is a guest blog post by Sara Plampin, Senior Instructional Writer from The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Sara Plampin - The Breakaway Group
It’s finally come, the day you’ve been working toward for years – Go Live. Thousands (or even millions) of dollars, hundreds of hours planning and calculating and going back to the drawing board, and it’s about to pay off. You sit back and take a breath, proudly watching as your organization takes its first steps into the future.

And then the complaints start to trickle in. The Electronic Health Record (EHR) feels clunky, it doesn’t match current workflows, documentation takes too long, and the physicians refuse to use it.

Frustrations over EHR functionality and increased documentation time are a leading cause of burnout among medical workers. Physician practices, in particular, are showing a decrease in EHR use over time. Physicians say hefty documentation requirements take away valuable face-to-face time with patients, making them feel more like scribes than doctors.

The issue has led to physician groups reviving the ‘Quadruple Aim’ movement, in which physician wellness is more emphasized.

quadruple-aim-of-healthcare-physician-wellness

While many are quick to attribute this dissatisfaction to the EHR itself, it is more likely the result of a poor implementation plan that focused more on technological requirements and less on long-term adoption needs. There are three ways to ensure the needs of physicians and clinical staff are met and you have a successful EHR adoption.

Involve Clinical Staff from the Get-Go
One of the biggest mistakes you can make is failing to include clinical staff in the initial decision-making process. Before choosing an EHR vendor, assemble a team of representatives from all areas of your organization – not just physicians and nurses. Ancillary departments such as therapy, radiology, and pharmacy are often overlooked when it comes to EHR design and training. Each representative will be aware of the specific needs and workflows for their department; they can compile requests from their colleagues and help research different vendor options to determine which EHR is the ideal match for your organization.

Once the EHR is selected, clinical staff members become an integral part of the design team. Although vendor representatives can help identify best practice workflows, ultimately your employees are the experts on how the EHR will be used in their department. HIMSS physicians cited five factors that contribute to EHR usability issues: navigation, data entry, structured documentation, interoperability, and clinical decision support. Involving clinicians in the design and testing phases allows them to identify solutions to some of these common issues, making the EHR more intuitive for future users.

Including members from all areas of the organization not only ensures better EHR selection and design – it also improves morale. When staff feel like their voices are heard, the project becomes a joint initiative rather than a regulation from upper management. Representatives from the design team act as a go-between, communicating their peers’ requests to executives, while in turn reinforcing the importance of the transition and garnering excitement for go live and beyond.

Realistic, Time-Effective Training
Once the EHR design is solid, the next step is to make sure all staff are properly trained and comfortable using the application. While this may seem obvious, training is another area where many organizations fall short. It is not just the amount of training that matters, but also the type and timing of training. Full-day classroom training sessions can be ineffective for adult learners. Additionally, planning training days around complicated shift schedules is difficult, as is finding replacement staff. This is particularly an issue at small physician practices, where physicians may have to sacrifice patient time in order to complete training.

A more modern, time-effective approach to training is online simulation. Learning is chunked into modules based on small tasks users may complete throughout their day. Thus, learning can be spread over days or weeks, whenever the physician has a free moment. Simulations allow learners to practice using the EHR, giving them the chance to fail without repercussions and develop muscle memory for daily tasks. By go live, using the EHR should feel like second nature.

A lot of the frustrations users feel about navigation and documentation requirements result from their unfamiliarity with the application. When they receive the right training, they will feel confident using the EHR, thus reducing documentation time and increasing face-to-face time with patients.

Constant Feedback/Reevaluation
As with all large-scale projects, even the best laid plans are bound to hit a snag or two. If you’ve established a solid communication channel with all department representatives, you will be prepared to handle any complaints that come your way after go live. It is important that all staff have a clear path to communicate problems and suggestions, and that they are comfortable doing so. The best way to avoid dissatisfaction among your employees is to hear their complaints and proactively fix these issues.

If you’ve already implemented an EHR and are now dealing with the types of complaints outlined above, this is the place for you to start. Create testing and measurement procedures to determine how users are currently using the EHR, where they are getting stuck and where their actions deviate from prescribed workflows. Then, work with each department to determine where EHR functionality can be tweaked, workflows redesigned or a combination of both. Effective adoption requires a constant cycle of communication, design, training, evaluation, and redesign.

If you want to make sure your employees are happy with the EHR and physicians avoid burnout, go live is just the beginning.

Xerox is a sponsor of the Breakaway Thinking series of blog posts.

Doctor Survey Can’t Muster Enthusiasm for Electronic Health Records

Posted on September 14, 2016 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

Medscape’s annual report on electronic health records (EHRs) is out for 2016. With more than 15,000 physicians over 25 specialties responding, there’s little to celebrate in it. The survey confirms what we know about the Meaningful Use program–it succeeded in getting doctors to use EHRs (slide 2) and to convert their paper charts to EHRs (slide 30). What the Meaningful Use program failed at, apparently, is meaningful use of EHRs.

When doctors were asked about the effects of the EHR on their practice, most reported “no change” (page 18). Yes, they say it has helped them with “documentation”–but how is that an achievement? Maybe you can get your thoughts into the record, but that’s of no value if it doesn’t improve patient service or clinical operations. In fact, the EHR has negative value. The survey confirms what we’ve heard anecdotally for years: the EHR is widely reported to slow down workflow (slide 25) and to dramatically degrade almost every aspect of the doctor-patient interaction: face-to-face time, management of treatment plans, etc. (slide 19). The text in slide 19 pallidly argues that, well, the results aren’t as bad as they were in 2014. Certainly, users will learn over time to compensate for bad systems, but that doesn’t turn them into good systems. If they were good systems, doctor satisfaction would have gone up since 2012–instead, it’s plummeting (slide 22). I have to admit that I don’t quite understand what the term “satisfaction” means in this context (as opposed, say, to the Rolling Stones song). I take the specific observations of slides 18 and 19 more seriously.

We can probably count as a success that 30 percent of patients review their data (slide 20). As a proxy for patient engagement, this doesn’t go far (and it happens during the visit, not online), but I bet hardly anyone used to review their data.

E-prescribing remains the most “helpful” aspect of an EHR (slide 17). This probably reflects the dominance of a single service, SureScripts, in that area. With little to worry about in terms of interconnection, the industry can exchange data relatively easily. Other areas of health care continue to struggle and falter when it comes to basic data exchange–for instance, only 35 percent of doctors found EHRs helpful to provide clinical summaries of visits to patients. When we can’t even get to square one on patient engagement, we have a lot left to demand of EHRs.

There’s a huge gap between hospitals and independent practices in their choice of EHRs. This suggests that the major EHR vendors are aimed at lucrative markets–the kind of enormous practices that run in buildings that tower above their urban landscapes. Epic, of course, is far and away the most popular hospital system (page 6). The market for independent practices looks like the Republican presidential polls early in the primaries–totally fragmented (slide 7). eClinicalWorks takes top spot with 12 percent of the market, and all the other services, many of them well-known, trail with single-digit shares of the market.

Strangely, when independent practices were asked to rate their EHRs (slide 11), the order was quite different. It may be that small samples and close margins make the differences between slide 7 and 11 insignificant.

The nice aspect of this finding (satisfying, one might say) is that independent practices really are independent. Doctors apparently do their research and choose what’s best for them. Large systems, by contrast, force their associated outpatient clinics to use the same system the hospital uses, regardless of its suitability or usability.

Ratings show what users truly think of EHRs. On a scale from 1 to 5, you might think that at least one or two might wander into the 4-to-5 range, but none receives that honor. The Veterans Administrations’ VistA interface (see our recent article on it) comes out on top of the pack (slides 8, 9 10, and 12), which is no surprise because it has been rated highest by doctors for decades. This popularity doesn’t help VistA in the fight for institutional dollars. A widely popular, open source, totally customizable, low-cost solution is no match against aggressive salespeople from vendors that cost a cool billion to install.

But to be fair, several major vendors come very close to VistA in popularity, and I don’t know what the margin of error is (for the survey as a whole, it’s +/-0.8 percent). Epic may well make just as many people happy as VistA. Furthermore, VistA’s rating fell a tiny bit over the past two years (slide 9) and it doesn’t show up at all among independent practices (slides 7 and 11). Vendors are also shuffled around a bit when doctors rate them for particular features, such as ease of use, vendor support, or connectivity. (Connectivity is an odd thing to rate, because it takes two to tango. If doctors rate a vendor well just for exchanging records with other providers using the same vendor, the whole point is lost).

There’s little age difference in doctors’ comfort using EHRs (slide 23). The reported revolt by older physicians doesn’t seem to be real. However, it may be that a truly transformative use of EHRs, with data and clinical decision support intensely integrated into the practice, would appeal more to newer members of the field. Perhaps slide 23 reveals that EHRs aren’t having much effect.

With all the dissatisfaction, 81 percent plan to keep their current EHRs. Perhaps that’s a resigned acceptance of how bad the field is; no alternatives exist. By the way, only 32 percent of the doctors have attested for Stage 2 of Meaningful Use (slide 29). How they’ll meet the requirements of the new MACRA law is beyond me. And unless real EHR competition picks up (in an industry that already has too many vendors), I don’t expect a radical improvement in vendor ratings in the 2017 survey.

EHRs Don’t Have to Be a One-Stop-Shop – Communication Solutions Series

Posted on May 16, 2016 I Written By

The following is a guest blog post by Brittany Quemby,  Marketing Manager of Stericycle Communication Solutions as part of the Communication Solutions Series of blog posts. Follow and engage with them on Twitter: @StericycleComms
Brittany Quemby - Stericycle
We have talked a lot about healthcare consumerism on this blog series, and it appears that as we discuss many topics, the importance and relevance of healthcare consumerism continues to grow.  More and more patients are demanding to be treated and have access to their healthcare as they would any other commodity they buy.

As I started to think more and more about patients as consumers, I started to think about my own buying behaviors.  If I were to be put into a category of buyers, what would I be? As consumers we don’t always fall into one particular bucket of buyers. We typically fall into several buckets of buyers depending largely on the type of commodity that we are buying. You may be a “One-Stop Shopper” or a “Bargain Shopper” for one thing, but become a “Research Shopper” for other things.

But what about when it comes to healthcare? Do we follow the same trends?  Typically when I shop, I’m a “One-Stop Shopper”.  I travel a lot for work and the convenience of a one-stop-shop significantly increases the time I have to do other things I enjoy. However, when it comes to my healthcare, I quickly become “The Researcher.”  I scour websites and reviews to ensure that I am getting the best healthcare I can.  I chalk it up to the fact that at the end of the day, I really don’t want to be getting my healthcare from the gas station around the corner from my house.

How we shop varies depending on a consumer’s lifestyle and what we are shopping for. But what about providers? Do healthcare providers receive the same liberties that patients have with their vendors?

Take shopping for an EHR for example.  Were physicians given the same consumer rights and liberties when it comes to EHRs? Do EHRs really provide everything a physician needs? The consensus is saying no.  Although studies have shown that EHR adoption rates have increased over the last few years, satisfaction rates from physicians have declined. Reports found that in 2010, 61 percent of respondents claimed they were “satisfied” or “very satisfied” with their EHRs, compared to just 34 percent in 2014.

So what happened? Did EHR vendors miss the mark?

Lack of Inclusion
A big portion of what went wrong can be linked back to the lack of inclusion from EHR vendor’s biggest consumer….physicians.  Many EHR vendors rushed to the market with software that dictated a user’s workflow rather than providing them with software that actually complements how they normally work. What transpired were cumbersome and difficult to use EHRs that significantly slowed physicians down.

Big Promises
EHRs had big promises for healthcare delivery and many doctors continue to be disappointed that they have not met their promises when it comes to quality, safety, efficiency and enagement.  A report titled “Physicians Use of EHR Systems 2014” found that 55% percent of physicians said it was difficult or very difficult to use their EHR to improve efficiency and 72 percent said it was difficult or very difficult to use their EHR to decrease workload. A far cry from the promise of efficiency and better patient engagement.

Interoperability
Another major drawback is the current lack of interoperability of EHRs with other products that exist in the market.  There is a growing number of healthcare platforms and technologies in the market that actually increase a physician’s quality, safety, efficiency and engagement, however many EHRs whether due to stubbornness or fear of loss of control have made it difficult for physicians to easily integrate with these platforms.

Needless to say, physicians are quickly realizing that their pseudo one-stop-shop of an EHR is not cutting it when it comes to satisfying the patient’s needs and their own needs.  Patients’ demands for things like access to their medical records, appointment reminders and mHealth have got physicians on alert for vendors who can deliver. Not to mention, their own demands for things like patient engagement tools and better overall efficiencies.  These crucial demands have begun to shift their buying behaviors to that of a healthcare consumer.  Many physicians are taking a stance with their own healthcare consumerism, recognizing that their EHR can’t and won’t be their one-stop-shop and have begun researching the market for the many niche products and vendors that can and will deliver better results and ultimately happier patients and a happier physician.

The Communication Solutions Series of blog posts is sponsored by Stericycle Communication Solutions, a leading provider of high quality telephone answering, appointment scheduling, and automated communication services. Stericycle Communication Solutions combines a human touch with innovative technology to deliver best-in-class communication services.  Connect with Stericycle Communication Solutions on social media:  @StericycleComms

Let Doctors Be Doctors – If Jay Z Sang EHR

Posted on October 19, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The medical world’s comedy rapper, ZDoggMD is at again with support from athenahealth. ZDoggMD just published a Jay Z parody video he calls EHR State of Mind which also promotes a new website called LetDoctorsBeDoctors.com. The timing of the video is interesting considering my recent blog posts on meaningful use dissatisfaction and one doctor’s dissatisfaction to name a few. I guess this post is a continuation of that theme. Enjoy ZDoggMD’s latest video on EHR and don’t let it hurt too much if it hits a little too close to home:

Op-Ed: Making Electronic Health Records Right

Posted on November 26, 2014 I Written By

The following is a guest blog post by Benjamin Shibata, MPH Student at GWU.
Ben Shibata
If you want to give hospital clinicians sever heart burn and arrhythmia, talk to them about implementing a new state-of-the-art electronic health record (EHR) system.  Although EHRs may seem like an intuitive improvement over paper health records, the transition to them has been a huge headache because the process is being forced rather than being organically chosen by the professionals using them.  Spurred along by the American Recovery and Reinvestment Act (ARRA), incentives to implement EHRs in a timely manner were laid out.  Although helpful in motivating hospitals to make the change, the ARRA has contributed to an overly expedited process that needs to be more thoroughly thought out.  In order to roll out EHR systems correctly, we need to understand how health records have historically improved medicine so that we can improve upon rather than complicate an already complicated system.

From a public health standpoint, EHRs should have been something implemented years ago.  HealthIT.gov explains how EHRs stand for improved efficiency and better patient care through greater care coordination.  And why shouldn’t they?  Electronic records are more portable and can be theoretically accessed anywhere in the world.  Doctors would have better access to their records, be able to practice more efficiently, and collaborate with other physicians to achieve the best possible patient outcome.  Unfortunately this is not what is being seen in many places for varying reasons: poor usability, time-consuming data entry, interference with face-to-face patient care, an inability to exchange health information, and degradation of clinical documentation are a few of the most common complaints based on surveys from RAND.

To better understand why these complaints are happening, we need remind ourselves of how health records came to exist in the first place.  Health records were first embraced in the 1920s when health care providers saw that keeping records in detail improved safety, treatment results, and quality of the patient experience.  Even though the process of keeping written records created an added burden, the transition from no records to records provided added benefits that the medical profession as a whole could not function without.  This contrasts very differently with what is happening with the rollout of EHRs – many systems are adding burdens with no perceived benefits.   This is ultimately leading to the friction we are seeing today.

Rather than improving their workflow and the patient experience, many of the EHR systems offered today are impeding it: 70% of respondents to a Medscape survey taken last July reported decreased face-to-face time with patients due to EHR implementation.  Although it can be argued that it is only a matter of time before physicians get used to and see the benefits of EHRs, large room for improvements clearly exist.  Healthcare providers do not reject technology because they are stubborn or unintelligent; they reject technology when it doesn’t work right just like the rest of us.  If EHR systems are to be embraced, they need to fundamentally change and improve the physician-patient relationship just like the original paper records did, and that change needs to be apparent.  The following is a list of things EHR developers should be mindful of:

  • Good EHRs are more than converting a paper record to a portable digital format. Improved portability is a game changer, but the burden associated with allowing portability needs to be balanced with that benefit.
  • The patient experience with EHRs is just as important as the physician experience. Although it is important to make sure physicians are satisfied, EHRs provide patients with the ability to access their health records like never before.  Improvements with the patient experience will motivate faster adoption of EHRs.
  • Efficiency is not everything.  An EHR that gives patients and physicians useful information that improves outcomes is much more useful than an efficient EHR that is efficient but does not provide as much information.

The shift from paper health records to EHRs is inevitable, and in that process we deserve to get EHRs right.  We should be confident that this will be achieved if we improve the experience, outcome, and relationship of both the patient and the healthcare provider just as it has been since health records were created.  At the end of the day, EHRs are about improving our healthcare system and not settling for anything less than the best.

Hospital Intern Time, Why ICD10?, and EHR Satisfaction Pre-MU

Posted on April 6, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.


Everyone that reads this immediately thinks that this is a terrible thing. It seems ghastly that a doctor that’s paid to treat patients would spend so much time with an EMR vs with patients. I agree with everyone that are highest paid resource should be using as much time as possible with and treating patients. However, this study would have a lot more meaning if it was paired with a previous study that showed how much time a hospital intern spent in a paper chart. Maybe they spent 400% more time with a paper chart than direct patient contact. Then, this stat would come off looking very different. You have to always remember that you have to take into account the previous status quo.


This article and the discussion around ICD-10 was phenomenal. Passionate viewpoints on each side. It fleshed out both sides of the arguments for me really well. Too bad no one will care too much for a while.


Oh…the good old days. When everyone love EHR, because they chose to do it and so they made the most of their choice. Ok, I’m being a little facetious, but I seem to remember a study I saw that showed how much more unsatisfied doctors are with EHR today versus pre-MU. I imagine it’s not all MU’s fault, but it certainly hasn’t helped with physician EHR satisfaction.

HITECH Answers EHR Satisfaction Survey

Posted on March 19, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The good people at HITECH Answers are conducting a survey to gage EHR customer satisfaction — 10 questions; takes 10 seconds. I think the questions they are asking are interesting and could provide some interesting results even if it’s not a real scientific survey.

So, if you’re a user of an EHR software, go and fill out the survey. If the results are valuable and interesting, I’ll be sure to share the results of the survey in a future post.