Physicians Survey Sheds Light on EHR Implementation Anxieties

In addition to being overworked and financially overextended, physicians are concerned about the effect EHRs will have on the care they provide patients, a recently released survey of 13,575 U.S. physicians reveals. 

The mammoth-size, 100-plus-page survey - commissioned by The Physicians Foundation, a nonprofit organization with members drawn from 20 signatory medical societies and associations - covered a number of areas, from feelings about finances to attitudes about patients. But it was, arguably, the comments and answers to technology questions by physicians that reflected a lingering sense of EHR anxiety among the medical community.

More than 69 percent of physicians surveyed indicated they have implemented EHRs. But not all of them believe their EHRs have improved (or will improve) quality of care.

Fewer than half (46 percent) of physicians who have implemented an EHR indicated their system has already improved quality of care or that they anticipate it will. Another four percent noted their EHR has, so far, decreased quality, but they expect things to turn around.

But one-third of those with EHRs - 31 percent - said their EHR has either had no effect on quality or has not improved quality, nor do they expect it to do so. And more than ten percent of EHR-holding physicians indicated the technology has actually decreased quality of care.

Physicians didn’t hold back their emotions about EHRs in the survey’s comments section. Aside from quality-of-care issues, one big complaint was the lack of compatibility and interoperability among EHRs.

“Until all doctors are on the SAME electronic network it’s a complete waste of time and money,” noted one physician. “There are so many different EMRs that are NOT compatible with one another.”

Another big issue is the cost of EHRs, especially for small practices.

“It would be a significant financial hardship (actually, financial impossibility) for me to begin using electronic prescriptions and /or EMR,” wrote one physician, who described himself as a solo practitioner with one full-time nurse and one part-time employee. “Not only the equipment and software costs, I simply do not have the revenue to hire someone nor the time to enter patient data, demographics, etc into a system of that kind nor the revenues to hire an IT person to manage and maintain it."

Walker Ray, vice president of The Physicians Foundation and chair of its Research Committee (and former practicing pediatrician), said he’s not surprised. Many physicians are already so overwhelmed with primary concerns - such as potential Medicare and private payer reimbursement drops, and the erosion of autonomy (not being able to give the care they want in a highly-regulated environment) - that implementing EHRs and adjusting to them can be highly stressful. 

“EHRs are seen as a necessity as much as a disruption,” Walker told Physicians Practice. “It takes significant distraction to implement EHRs. They will increase quality, [however], there’s no evidence they’re going to save physicians money.”

What does surprise Walker is the sheer number of physicians who have adopted EHRs, though it should be noted that the survey showed attitudes and adoption varied by age and other demographic factors.

“Younger physicians are a little more optimistic that electronic medical records can improve care,” said Walker.

Indeed, 63 percent of physicians age 39 and younger expressed optimism over the ability of EHRs to improve quality of care, compared with 47.5 percent of physicians age 40 or older. And primary-care physicians expressed more optimism than specialists, as did female physicians.

“As far as the EHRs go,” says Walker, “there is quite a diversity in physicians’ opinions on whether they’re going to help or not.”