The government’s push to deploy electronic health records across our medical system has driven physicians to the point of despair.
That’s among the key findings of a new study published in Mayo Clinic Proceedings, a medical journal. More than 5,100 doctors completed surveys on the usability of EHRs, or digital versions of patients’ medical history. The average grade was an “F,” which is “considerably below the usability of many everyday technologies.” Researchers then cross-referenced the doctors’ usability ratings with burnout rates and found that those who faced more difficulty using EHRs were more likely to report symptoms of burnout.
That’s a big threat to our health system. Doctors struggling with burnout are more likely to retire early, reduce their patient workloads, or leave the profession entirely. Perhaps most concerningly, burnt-out doctors are far more prone to make catastrophic medical errors.
President Obama started the government’s charge towards EHRs. During a speech at the Annual Conference of the American Medical Association in 2009, he promised that making the switch from paper to digital would “mean less paper-pushing and lower administrative costs” and that “all of you physicians will have an easier time doing your jobs.” Most important, he said that EHRs would “reduce medical errors.”
When President Obama made that speech, he’d already signed a plan—tucked into an economic “stimulus” bill—that provided billions of dollars to incentivize doctors and hospitals to “meaningfully use” a government-approved EHR system. Providers who didn’t make the switch by 2016 would see their Medicare and Medicaid reimbursements cut.
Consequently, doctors and hospitals rushed to implement EHRs. By 2015, 84% of hospitals had adopted at least a “basic” electronic health record system, up from 12% in 2009. Nearly nine in ten doctors’ offices had EHR systems.
But this mad dash meant that the technology wasn’t carefully developed to serve the needs of doctors and patients. The systems are so poorly designed that doctors have to spend a significant amount of time dealing with them rather than seeing patients. The Mayo Clinic Proceedings study noted that for every hour doctors spend with patients, they must spend an additional one to two hours on EHRs and deskwork. Plus, they have to devote another one to two hours outside the office on EHR-related tasks. All that extra work, combined with the poor usability of the technology, contributes to burnout.
Nearly eight in ten doctors experience feelings of burnout at least some of the time, according to a study from the Physicians Foundation. Consequently, nearly half of doctors plan to change career paths. Almost one-quarter expect to cut back on hours in the next few years. And about one in five plans to retire.
In other words, burnout exacerbates our existing doctor shortage.
Further, by causing burnout, EHRs put patients at risk of being the victim of a medical error.
An extensive investigation by Kaiser Health News and Fortune published earlier this year found that many EHR systems have glitchy software, poor user interfaces, and data errors. Separate systems often don’t interact with each other well. That can result in dangerous gaps in care.
Consequently, “alarming reports of patient deaths, serious injuries and near misses—thousands of them—tied to software glitches, patient records that get mixed up, user errors, and other flaws have piled up, largely unseen.”
Consider just a few examples highlighted in the investigation. A study in Health Affairs uncovered that more than 3,200 medical errors at three pediatric hospitals were due in part to “usability issues” of EHRs from 2012 to 2017. An analysis of one EHR system found that the technology was missing the correct start and stop dates for thousands of prescriptions and failed to track lab results properly. Another report found that in a test stimulation, EHR systems failed to flag about four in ten potentially dangerous drug orders.
In 2015 alone, hackers breached the electronic health records of more than 113 million people.
There’s no question that electronic health records have the potential to enhance efficiency and improve care. But the government-mandated sprint to adopt them has been a costly fiasco. There’s a lesson in this episode for future efforts to impose central planning on health care.
Sally C. Pipes is President, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her next book — False Premise, False Promise: The Disastrous Reality of Medicare for All — will be published by Encounter in January 2020.