Is Physician EHR Use a Detriment to the Patient Experience?

EHRs are supposed to improve the care experience for providers and patients. However, both groups have contrasting attitudes towards physician EHR use and its impact on the patient experience, a recent study published in Annals of Family Medicine found.

The EHR is intended to promote safe, efficient, and high-quality medical care, the researchers wrote. Yet, it has been previously described as a “third person” in the examination room. During clinical encounters, EHR use can change a healthcare practitioner’s eye gaze, posture, and attention given to patients.

“Entering health information, placing electronic orders, and retrieving results can be distracting to patients and practitioners,” Ellen C Meltzer, lead study author and internal medicine specialist at Mayo Clinic-Phoenix, and colleagues wrote. “When practitioners focus on their computer, dialog is easily disrupted and can lead to gaps in communication and patients feeling unheard.”

The survey of nearly 60 clinicians and 1,000 patients evaluated the impact EHR use has during face-to-face visits in the primary care setting. 

Practitioners all used the same EHR and had computers with monitors that could be positioned to face the patient. 

According to the findings, EHR use appeared to affect the clinician experience negatively. Nearly 79 percent of clinicians felt they maintained less eye contact when using an EHR system during a patient visit.

EHR use also seemed to impact clinicians’ ability to listen to their patients, with over 53 percent of clinicians saying that they think they listened less carefully during an encounter. Also, 62 percent said EHR use made the visit less personal overall.

EHRs can improve care quality, care coordination, and communication of patient information. Yet, clinicians less frequently reported discussing these positive aspects of the EHR with their patients.

In addition, fewer clinicians than patients agreed that the computer improved patients’ understanding of their health.

Two-thirds of providers felt that patients perceived EHR use as a generally negative experience, but the survey data showed that wasn’t entirely true. Patients generally had a favorable experience with practitioner use of the EHR during the clinical encounter.

Almost all patients reported that physicians maintained enough eye contact during the visit and listened carefully.

In addition, nearly 87 percent of patients disagreed that clinicians focused less on them and did not feel like the technology made the visit less personal.

Overall, more than 91 percent reported that clinician EHR use made for a positive experience.

Instead of focusing on the patient experience, the misperceptions of care involving EHR use prove the need for organizations to address increasing rates of clinician stress and burnout related to patient data documentation, the researchers stated.

Studies have shown that the rising EHR workload is linked to clinician burnout.

“Arguably, the primary drivers of burnout for physicians have been related to electronic health records and overwhelming inefficiencies in clinical practice that significantly and negatively impact workflow and patient care,” experts wrote in a Journal of the American Medical Informatics Association (JAMIA) study. “Physicians experience high fatigue with short, continuous periods of EHR use, which is also associated with inefficiency of EHR use (ie, more clicks and more time) on subsequent cases.”

As clinician burnout increases, so does clinicians’ likelihood to leave their organization, suggesting that addressing the problems of burned-out clinicians could help mitigate turnover.

By prioritizing health data interoperability and user-centered EHR design, EHR vendors can tackle administrative burdens contributing to clinician burnout.