Doctors give electronic health records an ‘F’

On a scale that measures the user-friendliness of various everyday technologies, doctors rank Google 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, comes electronic health records, according to a study published online Nov. 14 in Mayo Clinic Proceedings.

Doctors gave EHRs, now in widespread use across the country, an “F,” according to the study, which links the poor grade to worrisome levels of physician burnout.

“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 jointly by Stanford, 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, an oncologist who treats patients and is familiar with the difficulties around the use of EHRs. The list of activities physicians use EHRs for is complex and includes clinical documentation, an explanation of clinical decisions, the ordering of medical tests, and other administrative and clerical tasks.

In the study, researchers specifically analyzed the impact of EHRs on physician burnout. A quarter of the respondents were asked to complete a technology usability questionnaire known as the system usability scale, a standard assessment for evaluating the usability of technology. The results from the 870 physicians who completed this assessment showed EHRs with a ranking of 45  out of 100 on the SUS scale. This was far below Google’s SUS score of 93 and below Excel’s ranking of 57, 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, who also is a professor of medicine at Stanford, where he holds the Jeanie and Stew Ritchie Professorship. He 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  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.”