Docs argue whether EHRs to blame for administrative burdens

While a number of studies have indicated that electronic health records increase physicians’ administrative burdens, not all physicians share that point of view, as evidenced by a recent exchange published in JAMA Internal Medicine.

Earlier this year, research published in the journal found that primary care physicians (PCPs) spend more than an hour a day simply dealing with the notifications that they receive from their EHRs, such as test results, requests for medication refills and messages from other providers. The researchers, from the Houston Veterans’ Affairs Center for Innovations in Quality, Effectiveness and Safety, found that PCPs received a mean of 76.9 notifications a day. Extrapolating the information, the results suggest that physicians spend about 67 minutes a day processing notifications, making it harder to discern which ones are more relevant and increasing the risk of overlooking abnormal test results.

In a letter to the editor, several physicians agreed that while there should be better EHR design and staffing strategies, the EHR itself was not the culprit increasing physicians’ burdens, since the study didn’t take into account historical or control data for comparison. They noted that paper records were also burdensome and that EHR notifications can “substantially” enhance care coordination, patient engagement and safety.

The authors of the initial study responded, saying that EHRs provide measurements to inform new reimbursement models, but disagreed about their effectiveness. They noted that EHRs increase physicians’ accessibility and ability to keep them in the loop regarding a patients' care, but are still designed in such a way as to inordinately consume providers’ time, such as the need for excessive clicking. In addition, EHRs “continue to fare poorly as curators of information, often presenting critical information at inappropriate times or burying it among vast amounts of minutiae,” they noted.

“Our work provides impetus to explore how the EHR can be used to remove mundane work from PCPs rather than increasing it and to leverage team-based approaches to managing notifications," they said. "With almost half of PCPs experiencing burnout, we would argue that addressing something so deeply ingrained with their work lives would be a good place to start."

To learn more:

- read the letters here and here