Eight medical professionals discuss with Healthline the benefits and drawbacks of having to keep electronic health records.
Does your insurer or hospital group offer a “patient portal” where you can access records, communicate with your doctor, and see your prescriptions and appointments?
Thank electronic health records (EHRs).
EHRs have changed the way doctors note, record, store, and share patient information making them more accessible to patients, fellow doctors, and specialists compared to paper filing procedures.
But the time and effort spent recording information in EHRs may be coming at the cost of physicians’ health, several recent studies suggest.
In a recent Brown University study of 4,200 practicing physicians published in the Journal of the American Medical Informatics Association, 91 percent used EHRs. Of them, seven in 10 reported at least one measure of EHR-related stress.
The study also indicated doctors who are not allotted enough time to fill out EHRs were 2.8 times more like to suffer symptoms of burnout compared to those with more accommodating schedules.
In addition, a 2018 survey from The Physicians Foundation found that nearly eight in 10 doctors experienced symptoms of burnout and that EHRs were one of the top two factors doctors disliked about their jobs.
So, electronic records are good for patients but seemingly a problem for doctors.
To figure out the way forward, Healthline talked to eight medical professionals to get their take on EHRs — and whether they’d ever go back to paper.
Dr. Ken Robinson, FACEP, Southern California Permanente Medical Group
Years practicing: 25
Robinson says he spends about 30 percent of his day filling EHRs out and another 20 percent ordering and reviewing results and data.
On the stress of keeping electronic records:
“The implementation of the electronic health record (EHR) forever altered the dynamics between patients and physicians. The relationship is no longer a binary doctor-patient relationship but a triangle: a doctor-patient-systems relationship, and the EHR became a third wheel compared to the more elegant, but ineffective, piece of charting paper.”
What can be done to make EHRs better:
“The EHR must evolve beyond a database into a tool that provides only the necessary content, orders, data at the right time. Also, physicians need to be taught the optimal way to use these systems.
“It became clear that our physicians reported similarly negative impact to the patient-physician relationship, as well as doctors’ well-being and joy [as these studies].
“In response, a group of us — EHR expert physicians, trainers and support staff — were sponsored to create a peer-led educational program.”
On whether they’re a net benefit or drawback:
“The net benefit far outweighs any drawbacks, especially if the physicians using the system are given adequate peer-led training that teaches them how to use the system efficiently and effectively.
“I would never go back to paper.”
Jameca Woody Falconer, PhD, a licensed psychologist in St. Louis, Missouri
Years practicing: 17
On the stress of keeping electronic records:
“Electronic health records makes my life and my practice much easier. I can access notes and charts and I don’t have to worry about maintaining records because it is all stored online.
“It makes business much easier. It saves the cost of paper and printing and helps to streamline costs of storage.”
On whether they’re a net benefit or drawback:
“Definitely a net benefit. The cost that I pay for EHR is worth every penny.”
Dr. Arun Villivalam, MBA, family physician in Los Gatos, California
Years practicing: 17
Villivalam described himself as a “reformed EHR evangelist” who once traveled the country preaching to fellow doctors that “using an EHR would be the ultimate answer.”
Now, he’s less sanguine — having used six of the major EHR systems — but still believes in the ultimate benefits of electronic record-keeping.
On the stress of keeping electronic records:
“There is stress with both approaches, but overall EHR’s tend to be more stressful for physicians because they require more work than just using paper records. The stress improves with time as EHR familiarity improves.”
What can be done to make EHRs better:
“EHR’s challenges are focused more on extended time with charting (process is cumbersome compared to paper), inappropriate use (overuse) of messaging / communication with staff and providers and between providers / staff and patients, and sporadic unreliability.
“Regardless of paper records or an EHR, the rules regarding documentation and payment likely cause most of the stress in all situations.”
On whether they’re a net benefit or drawback:
“Ultimately, I think EHR’s provide a net benefit because of the more powerful data access.
“I would not be able to travel as I did before and make the same argument that I did before about EHR’s unequivocally, but I would suggest that they do have some major advantages over paper records which have to be shared more widely.”
Dr. Christopher Maiona, chief medical officer at PatientKeeper Inc., Waltham, Massachusetts
Years practicing: 20+ years
On the stress of keeping electronic records:
“With EHRs, we should have better access to patient information, but it’s often buried in a sea of redundant or irrelevant data, or it may be in an inconsistent format, which makes finding the pertinent information challenging.
“Invariably, they slow me down, and over the years they’ve come to demand more of my time. ‘Feeding’ the EHR has become a job in itself. What ought be an asset has become a hindrance.”
What can be done to make EHRs better:
“Imagine having a computer system that can help streamline the process by highlighting critical overnight changes and helping prioritize daily tasks in an intelligent manner that is consistent with how that physician practices. Such a breakthrough would get physicians on the floor sooner and to the patient’s bedside earlier.”
On whether they’re a net benefit or drawback:
“Technology should not burden physicians. Rather, it should be a valued resource to help them be a little sharper, more efficient, and better equipped to interact more frequently with patients.”
Dr. Velimir Petkov, board-certified podiatrist in Clifton, New Jersey
Years practicing: 10
On the stress of keeping electronic records:
“[EHRs] minimizes wait times and practically eliminates man-made errors. My staff also saves valuable time, not having to scan forms and insurance cards/IDs, process payments, etc. They don’t have to call insurance companies to verify benefits as much, as most of them display eligibility directly in our system.”
On his patients’ experience:
“Having no paper forms is great and people love it because most don’t like how long it takes to fill out multiple pages by hand. It’s a lot easier clicking on a device.
“My patients also have an access to a secure online portal (powered through our EHR). It allows them to contact my staff online with any billing questions. But it also gives them a secure way to communicate directly with me — pre- or post-visit.
“They can see all of their information, along with X-rays, lab results, and prescriptions online on their computer or cell phone.”
On whether they’re a net benefit or drawback:
“In my practice, we use Athenahealth for EHR and Yosi for electronic check-in. I personally see tremendous benefits in using both. “
Dr. Caesar Djavaherian, co-founder and chief medical officer at Carbon Health in San Francisco
Years practicing: 17
Using legacy platforms such as Epic and Cerner, Djavaherian says he can spend four hours or more on an eight-hour shift filling out records. Newer systems suggest improvement, however.
On the stress of keeping electronic records:
“I believe that there is a considerable amount of administrative burden placed on doctors to use new EHR technology that doesn’t contribute to or enhance the experience but instead gets in the way of patient care.
“Doctors have to spend a lot of time clicking through different pages for tasks that could have otherwise been handled quickly. For example, a prescription… takes a longer amount of time to enter using an EHR.
“Previously, doctors were used to spending a lot of time with patients and documenting their experiences, and now it seems like we’re spending less time interacting with them and more time entering information into EHRs.”
What can be done to make EHRs better:
“With the next generation EHR, I spend 60 to 90 minutes during the course of an eight-hour workday, where I see 25 to 30 patients daily.
“The legacy health records were built on old platforms and never really optimized or enhanced the patient-doctor experience. However, the new EHR enables a better experience for both doctors and patients.
“At the same time, a constraint linked to transmission of EHRs is the interoperability issue -— they aren’t particularly useful for doctors to transfer to another health system.
“At Carbon Health, we use a next generation EHR that allows interoperability, which makes it easy to transfer records to a legacy system.”
On whether they’re a net benefit or drawback:
“A major benefit of EHRs is that they provide a complete record of the patient experience, and this can be easily transmitted to other people within the same health system.
“When it comes to the future of EHR, I think an effective route to take would be to implement machine learning models (something that we are implementing at Carbon Health) that provide a treatment plan based on prior experiences with patients who have exhibited similar symptoms.
“By implementing these models we can speed up the EHR process and doctors can focus on what matters the most – the patients.”
Dr. Mukul Mehra, chief technology officer and co-founder of IllumiCare in Birmingham, Alabama, and a practicing gastroenterologist
Years practicing: 14
On the stress of keeping electronic records:
“The transaction database has de-humanized medicine and led to physician burnout as screen spaces supercede visual cues, documentation burdens create anxiety, and the element of touch is outweighed by hands on the keyboard.
“Many of us feel like documentation entry specialists and are judged by the length of the note and the ability to code complexities rather than solve complex cases.
“No EHR or AI technology can recreate or assist with the art of the history-taking piece [of medicine]. It can’t even be transcribed because that interaction is real, fluid, interactive, multi-sensed, and the heart of medicine.”
What can be done to make EHRs better:
“In an effort to de-tether the physician to the EHR and improve the decision-making capabilities the technology has the potential to augment, I created IllumiCare and the Smart Ribbon. This EHR-agnostic, unobtrusive ribbon of information provides clinicians with important clinical and fiscal, patient-specific data when they are making decisions in the EHR.”
On whether they’re a net benefit or drawback:
“The EHR can be valuable, and we need to make the information clinicians spend so much time entering more actionable.”
Dr. Russell Libby, a pediatrician in Fairfax, Virginia, and board member of the Physicians Foundation
Years practicing: 38
On paper records:
“I will give you a perspective on the old way.
“The fact was you had patient charts and you had people who were in charge of putting together those charts. You had charts that were often and almost always disorganized and pieces of paper in there that were irrelevant and sometimes from other people’s charts.
“This was not necessarily a great way to do it. You would get called during the day, maybe end up with a note from your nurse and write in answers from the nurse, dump it into a stack, and theoretically, at the end of the day, it would go back into your chart rack.
“The only thing you really hoped is it went back in the right alphabetical order because sometimes patients’ charts were lost forever.
“The notion that we had a better way of doing it was rather misbegotten.”
On EHRs:
“Right now we are capable of but have not designed the kinds of EHRs that would make life better for people.
“The fact you have to hire a third person to be in the room with you — a scribe — because the EHR isn’t capable of using its artificial intelligence to be able to understand where and what and how to translate what your encounter represents into a more meaningful record is crazy.
“Because I think we have the technology and ability to do that but, it needs to be implemented, needs to be affordable, and needs to be able to take the place of these legacy systems.”
What can be done to make EHRs better:
“The way we’ve designed [EHRs] is primarily for transaction-based, fee-for-service medicine, whether that be fulfilling certain criteria for recognition of quality, recording certain data that allows you to capture enhanced for maximal revenues.
“It’s not facilitating the actual patient-physician encounter. And it isn’t necessarily giving the value to that visit you could get if you had a better design or more innovative ways to capture data and to categorize it the way that would allow you to fabricate a much better patient-physician encounter.”
On whether they’re a net benefit or drawback:
“I’ll be darned if I think going back to a paper record and having those charts in an office somewhere that really is irrelevant to the moment when you might need it is a step in the right direction. “