Poor EHR Usability Linked to Burnout Rates

As financial incentives from the Meaningful Use act continue to roll in, more and more private practices are adopting EHR systems — thus totally transforming the landscape of how care is delivered and archived. Electronic health records are designed to create a secure web of patient data information that is accessible, easy to use, and transparent, all while offering financial incentives to the providing medical practice or institution. In reality, as we now know, these EHR’s are far from perfect.

A 2019 study published in the Mayo Clinic proceedings found that perceived usability of EHR platforms was directly linked to the degree of job satisfaction and burnout among clinicians. The more difficult an EHR is to use, the more likely a clinician is to feel burnt out. But what exactly makes EHR’s so unfriendly, and why are users so dissatisfied?

Interoperability and Difficulty Switching Vendors

Interoperability refers to the ability of computer software to share data and information laterally across different systems. EHR software is notoriously incapable of efficient interoperability. This lack of seamless integration between software makes sharing patient information across institutions or between medical professionals with different expertise extremely difficult.

From a business perspective, these tactics are often intentional. Keeping care providers and medical institutions locked into a specific EHR platform is financially advantageous for vendors and because the costs of implementing a new EHR system are so high (especially for larger practices like hospitals), it ensures that their customers won’t switch platforms if a newer, better, or cheaper alternative becomes available.

Because EHR platforms can’t play well with others, bigger healthcare institutions often employ a more umbrella-like platform that “works” for everyone rather than letting each department contract their own vendor that serves their specialty-specific needs.

Incompatible Priorities

For the majority of clinicians, providing care to patients is the primary reason they pursue medicine in the first place. The priority for EHR companies and hospital administrators, however, is not as altruistic. Their primary objective, shaped by language from Meaningful Use and incentives from the US government, often means that their operating systems are angled towards billing, revenue, and insurance claims. The needs of hospital administrators and claim adjusters are decidedly different from the needs of clinicians, specifically in regards to their workflow and documentation.

Specialty Based Shortcomings

One of the biggest difficulties facing medical professionals in their struggle against EHR’s comes from specialty based shortcomings within the individual EHR platforms. Generally, the software works when logging basic patient information or documenting symptoms, but difficulties arise when inevitable irregularities throw off the somewhat binary nature of the EHR software.

For example, a doctor seeing a patient with hyponatremia may need to make a lab order for custom fluids, but because they must document and place the order through the EHR, they are working under the constraints of the platform. Imagine in this case there is only a dropdown menu of available fluids, so the doctor spends hours trying to manually subvert the system's constraints by exploring all possible order permutations, only to ultimately fall short. Or, like in some horrific cases, place the order only to discover sometime later that the EHR software and the order technology used at the lab level are not interoperable — leaving the order to swirl around hopelessly somewhere in the technological limbo, and leaving the patient without their fluids.

Less flagrant shortcomings pop up on a daily basis within almost every practice. Genetic Counselors, as an example, must chart patient pedigrees in order to understand the patient’s susceptibility to certain genetic conditions. Many EHR’s don’t have these pedigree templates built into their software, often leaving Genetic Counselors to draw the family tree by hand before scanning and uploading to the EHR. Some third party EHR integrations exist to ease this specific need, but were developed only after enough GC’s made enough noise that a third party company found it profitable enough to pursue. Many other specialties, with their equally nuanced needs, are not as lucky. These small inconveniences, compounded daily, can become incredibly suffocating over time, and care providers are spending far too much time trying to complete simple tasks.

Impact of Poorly Designed EHR’s on Physicians

A Stanford Medicine poll found that almost 60% of primary care physicians feel that EHR systems need a complete overhaul, and 54% reported that EHR documentation detracts from their job satisfaction. To compound on these findings, Medscape’s 2021 Physician Lifestyle Report found that bureaucratic tasks were the primary cause of burnout amongst physicians, and 1 in 5 reported having some level of depression (69% clinical depression, 20% colloquial depression, 11% other).

Reported System Usability Score (SUS) of EHR system by specialty — Courtesy of Mayo Clinic Proceedings

Additionally, the Medscape report found that 13% of all physicians have had thoughts of suicide within the past year alone. It’s disingenuous to attribute all of these findings to the shortcomings of EHR’s, Medscape themselves notes this, saying that “some specialties may be prone to more stress, greater danger from caring for COVID patients and higher levels of burnout and depression.” But the numbers are clear in one irrefutable regard: physicians’ biggest source of job dissatisfaction comes from EHR-related administrative tasks and clerical work.

Stanford’s 2020 Health Trends Report found a strong correlation between EHR usability and burnout, with 52% of respondents citing their challenges with EHR platforms as the primary cause of their burnout. These findings persist despite growing numbers that suggest doctors today are more data driven and open to new technology like EHR’s than their predecessors. The report suggests that “high readiness for EHR’s does not correlate with physician satisfaction of the technology itself.” Or, in the words of Linda Girgis, MD, who wrote a rather pointed article against EHR’s

“Technology advances much quicker in medicine than any other sector. Doctors are using robotics and genetics for precise treatments that were not available just a few years ago. We are not averse to trying new technology. This technology improves outcomes and saves lives. However, we do not race to incorporate technology [that is] not what it is purported to be and [instead] actually takes time away from activities that can improve our patients' health.”

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Solution Based vs. Transformative Approach — The DeepScribe Difference

Unlike some of the third party companies mentioned above that take a solution based approach to EHR relief by addressing one specialty-specific need, or one element of a workflow, we are much more interested in a transformational approach that is capable of changing the entire industry.

Instead of attacking just one issue, we are taking on the system by building an all-encompassing tool that automates the entire documentation process by using advanced AI and voice recognition software. At DeepScribe, our AI-powered medical scribe captures patient encounters in real time, automatically create medical notes, and integrate those notes into the discrete fields of some of the leading EHR platforms. Providers can simply review and sign off.

Our transformative approach will totally change how care is imagined, and by automating clerical tasks, we give physicians their lives back and allow them to bring the joy of care back to medicine.

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