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Doctors give electronic health records ‘F’ rating, study says

Electronic health records are not user-friendly according to a survey of physicians, which also linked these results with burnout.

On a scale that measures the user-friendliness of various everyday technologies, Google, not surprisingly, ranks right at the top. Microwave ovens, aren't far behind, followed by ATMs. Microsoft Excel hovers somewhere near the bottom. And then, well below that, when ranked by physicians, comes electronic medical records, according to a study published online in the Mayo Clinic Proceedings.

Doctors gave these medical technologies, now in widespread use across the country, an "F" ranking, according to the study which also links the poor ranking to worrisome levels of physician burnout, according to the researchers.

"At the end of the day, we want these electronic tools to support and facilitate the delivery of the care patients' need," said Tait Shanafelt, MD, senior author of the study and director of Stanford's WellMD Center. "Right now, they're often a distraction of physicians' attention away from patients." The study was conducted by Stanford jointly with Yale University, the Mayo Clinic and the American Medical Association.

As recently as 10 years ago, doctors kept medical records by jotting down notes on paper. Following federal legislation in 2009 that provided $27 billion in incentives to encourage the adoption of electronic health records, their use is now commonplace. Physicians sitting in front of computers typing in data while treating patients has become routine.

"These are complicated tools that are being used for multiple purposes," said Shanafelt, who, in addition to his research, also is an oncologist who treats patients and is familiar with the difficulties around the use of EHRs. The list of activities physicians use the EHR for are complex and includes clinical documentation, an explanation of clinical decisions, ordering of medical tests, billing information along with other administrative and clerical tasks.

Since 2011, Shanafelt has led a national study of U.S. physicians every three years in collaboration with the American Medical Association, and colleagues at Stanford and the Mayo Clinic. In 2017, the most recent study revealed that 44% of physicians had symptoms of burnout, which is lower than they were in 2014 but markedly higher than U.S. workers in other fields. In the current manuscript, researchers specifically analyzed the impact of EHR, just one of the the contributing factors to physician distress.

A quarter of the respondents in the nationwide survey were asked to complete a technology usability questionnaire known as the System Usability Scale, a standard assessment used to evaluate the usability of technology. The results from the 870 physicians who completed this assessment, showed EHRs with a poor ranking of 45 -- out of 100 -- on the SUS scale. This was far below Google's SUS score of 93 and well below Excel's ranking of 57 right on the low end of the scale.

Among this same group of 870 physicians, 865 also completed a separate burnout survey. The results revealed a strong correlation between how doctors ranked EHR usability and burnout. Wide variation in EHR usability was observed by specialty.  Certain medical specialties, such as dermatology orthopedic surgery and general surgery, ranked the usability of EHRs particularly poorly. 

"These tools are, to some extent, one size fits all and may meet the needs of one specialty better than others" said Shanafelt.  Shanafelt said he has experienced firsthand how hard it can be to adjust to a new EHR when he moved from the Mayo Clinic to Stanford after 15 years and had to learn to use a new EHR system.

"It's a massive undertaking," he said. "It probably can take multiple years to learn a system well. There are a lot of inefficiencies in these systems and many of those land on the shoulders of physicians." 

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