Perception Vs. Reality: Debunking the Fake News of EMRs

If you are monitoring the healthcare media these days, there is a disturbing number of reports vilifying the EMR as being unusable and driving physician burnout. How much of this is sensational journalism? What is the current reality? The KLAS Arch Collaborative EMR usability and clinician satisfaction research was initiated to delve into the challenges facing EMR use.

No one can dispute that the EMR has failed to meet expectations established in pieces like ‘Paper Kills — Transforming Health and Healthcare with Information Technology,’ which was written in 2007. EMRs were to be the facilitators of high-quality and low-cost healthcare that would drive improved care-delivery outcomes and patient safety. The EMR was also supposed to increase patient and clinician satisfaction.

What happened? Well-intentioned academics implemented Meaningful Use (MU). The availability of big money from the government propelled many providers to select and implement EMRs that met the necessary functional requirements and supported quality outcomes reporting that was tied to reimbursement.

Very few provider organizations created EMR-implementation strategies for the MU-funded EMRs that extended to supporting care delivery. This resulted in implementations that supported billing and coding processes. Clinicians were transformed into data-entry clerks, and the EMRs provided very little return value to the clinicians for improving care delivery.

Yes, the EMR has been a disappointment at best.

But KLAS wanted to find out if providers were as unhappy as the media made it appear, and what organizations can do to make the best of their EMRs. To date, nearly 100 provider organizations worldwide have sought end-user feedback through the Arch Collaborative. The results of our findings have been shocking, to say the least.

Shocker #1: Many of the fixes needed to improve EMR usability and clinician satisfaction are not technical!

EMR satisfaction has a strong correlation to three key findings:

1. The Initial EMR training and follow-up education clinicians receive establishes a solid foundation for success that retains high levels of clinician satisfaction over several years.
2. The more clinicians use EMR-personalization tools to support their care-delivery workflows, the more satisfied they are. Most organizations tend to focus on the EMR customizations that facilitate inputting data efficiently — in other words, settings that turn clinicians into data-entry clerks.
3. Ensuring that clinicians receive appropriate personalization training for efficiently extracting patient data results in higher EMR satisfaction. Wasn’t ease of access to patient data a key promise of the EMR’s potential?

The factor with the highest impact on clinician satisfaction is organizational culture, which is the foundation for EMR governance. How many times does an organization tell a clinician, ‘no,’ instead of, ‘let’s discuss some potential solutions’? If clinicians feel that leaders aren’t listening, they give up, and EMR satisfaction goes down the drain. Another point of frustration is having each change/enhancement request go through multiple approval committees. This pattern results in requests taking six months to two years to be approved.

Shocker #2: The AMA may not have the full story; the EMR is not the key factor in physician burnout.

The Arch Collaborative findings show that over 90 percent of clinicians either agree or strongly agree that they feel fulfilled in their profession, but many fulfilled clinicians have low EMR satisfaction scores. This indicates that the EMR may be a convenient scapegoat for those seeking to solve clinician burnout. Placing all the blame on the EMR means we may fail to consider other professional and lifestyle factors that are driving burnout.

This is not to say that a poorly implemented, supported, or designed EMR doesn’t contribute to physician burnout, but EMRs should be appropriately reviewed as one of many potential factors, instead of the smoking gun.

Shocker #3: Provider organizations in which most clinicians are satisfied with the EMR do exist.

This is the most exciting part of the Collaborative research. We get to expose provider organizations who have some of the best practices. KLAS’ research found high EMR-satisfaction scores at some large healthcare systems, medium healthcare systems, community hospitals, county hospitals, and ambulatory care groups.

Shocker #4: All of the major EMR vendors have some highly satisfied customers and some highly unsatisfied customers.

The Collaborative research is not a blood sport for identifying the best EMR vendors. In fact, it shows that any organization that focuses on the points outlined above (in shocker #1) can improve their providers’ EMR satisfaction.

Shocker #5: International organizations have similar EMR challenges.

Collaborative members from the UK and Australia are validating many of the same EMR challenges and opportunities for improvement that we find in the US.

What’s Next?

The issues providers have with EMRs are complex, and they aren’t going to disappear overnight. However, KLAS believes that gathering data, analyzing it, and comparing it across organizations, usability can improve.

And so, rather than focus on “fake news” regarding EMRs, let’s work toward real solutions.

[Mike Davis is Arch Collaborative Lead Analyst at KLAS. For more information about KLAS, click here. To follow KLAS on Twitter, click here.]