"This survey adds to the growing body of evidence that a significant percentage of physicians, including urologists, continue to see shortcomings in their EHRs," writes Robert A. Dowling, MD.
Robert A. Dowling, MDMedical Economics recently published the results of its fifth annual EHR Report (bit.ly/MedEcEHR2017), a survey that this year included urologists among its respondents. The questions put to readers addressed a wide range of issues, including physician and staff satisfaction, EHR functions, and EHRs’ impact on the delivery of patient care. While the survey has some limitations and may or may not be generalizable to a larger group of physicians, it does provide a perspective on a range of opinions-including those of urologists.
In this column, I highlight the responses of urologists and where urologists seem to differ significantly from the other specialists surveyed.
Where is the EHR industry in terms of adoption? The implementation and adoption of EHRs in the U.S. was catalyzed by the HITECH Act (part of the American Recovery and Reinvestment Act) in 2009 and the incentive program popularly known as meaningful use. Thus, in the modern era, anyone using an EHR for more than 9 years could be considered an “early adopter,” 5-9 years a “majority,” and 1-4 years a “late adopter” (Rogers, Everett M. Diffusion of Innovations, 5th Edition. New York: Simon and Schuster, 2003). It is not surprising, then, that many of the majority and early adopters have used more than one EHR, including the respondents to this survey. The survey included many questions designed to understand the reasons for switching EHRs.
Where are urologists in terms of adoption? Among the survey’s urologist respondents (155), 16% are early adopters, 41% late adopters, and 43% majority. This majority is significantly higher than family medicine but not other surgical specialties. Sixty-four percent of urologist respondents are on their second (26%) or third (38%) EHR.
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The most common main reasons cited by urologists for switching EHRs were a change in practice (46%), linking to other systems (practice management) (16%), and a desire for better customization (15%). Less common reasons cited were complaints about the system or the vendor.
Taken together, the results suggest that survey respondents were more likely to have switched EHRs mainly because of an organizational decision rather than an individual concern about the product or service. Mergers and acquisitions of practices could represent reasons for switching EHRs.
Are urologists planning to switch EHRs? Seventeen percent of urologist respondents indicated they were considering switching EHRs. Among this minority, the most common reasons cited were seeking better vendor support, an ability to customize, and quality metrics to comply with the Merit-based Incentive Payment System. Most of the urologists surveyed, though, are staying put for now.
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The results here suggest that features are important to urologists, including the ability to customize their experience with information systems. EHR vendors have long struggled with finding a balance between physicians’ resistance to standardize their documentation and the promise of structured data entry, and data, to create value and efficiency in the medical record. The benefits of customization include adapting a flexible design to a wide variety of users.
Customization can have unintended consequences, though, including but not limited to incomplete records, incorrect records, patient safety issues, and rendering accurate data retrieval useless. If these results are generalizable and statistically significant, it suggests an enduring role and market for EHR design that is “tailorable” to a specialty and an individual.
How concerned are urologists about a potential data breach? While urologist respondents are relatively more concerned about data security and breaches than other specialties surveyed here, almost half of respondents indicate they are unconcerned. In view of the increasing number of well-publicized data breaches in health care generally and urology specifically in the last 2 years, the survey results suggest a persistent lack of awareness or understanding of the liability incurred by custodians of health care data. (Also see, “Are you taking steps to prevent data breaches?”). Sixty-five percent of urologist respondents indicated they have dedicated in-house IT staff. Survey results suggest the need for continued education on the risks in this area, the importance of basic security procedures, and the consequences of a health care data breach, including but not limited to physician liability.
Also see: What urologists can learn from EHR fraud case
How satisfied are physicians with their EHR? Only 6% of urologists responded that they are “very satisfied” with their EHR, compared to 13% of family physicians. About half of urologists surveyed would recommend their EHR to a colleague. Top reasons cited by this specialty for not recommending their EHR included a lack of concern for physician time, not meeting current needs, and issues with customization.
Urologist respondents’ top box scores on implementation and productivity were generally consistent with their primary care colleagues and the survey respondents as a whole; urologists were not as likely to give top box scores and had a lower mean score compared to primary care for customer service.
Top improvements to care attributed to the EHR cited by urologists include e-prescribing (77%), health information exchange (37%), and patient portal (37%)-consistent with other specialties. Top disadvantages included the burden of data entry (82%), workflow disruption (68%), and interference with patient eye contact (63%).
Are the survey results consistent with those of other EHR surveys? The “Deloitte 2016 Survey of US Physicians: Findings on health information technology and electronic health records” concluded that three out of five physicians would keep the system they currently have, yet 75% believe EHRs costs outweigh savings, and 70% believe EHRs reduce their productivity (bit.ly/DeloitteEHRfindings). Why are physicians loyal to their EHR in the face of apparent negativity? Neither the Medical Economics survey nor the Deloitte study specifically addressed this question, but other surveys have identified a number of challenges in changing EHRs: time investment, loss of productivity during the transition, new learning curve, cost, and challenges related to migrating data (Fam Pract Manag 2015; 22:13-8).
Bottom line: This survey adds to the growing body of evidence that a significant percentage of physicians, including urologists, continue to see shortcomings in their EHRs. While the sample size is small, the results are consistent with other surveys and clearly identify areas of opportunity for improvement-a road map for EHR designers of the future.
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