EHRs: Heartache & Helpmate for Cardiologists

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The VA Clinical Assessment Reporting and Tracking (CART) program was developed specifically for cardiologists in the VA system,
Source: Tamara Box, PhD, Health IT Lead, Denver VA Medical Center

According to a recent American College of Cardiology (ACC) survey, nine out of 10 cardiologists run EHRs in their practice. For eight out of 10, those EHRs are two or more years old. However, even with so many practices using EHRs, only 35 percent of respondents were relatively satisfied with their EHR. CardioSurve, which invites a panel of more than 350 ACC members to respond monthly to topics of interest, conducted the survey.

Similarly, responses to a survey by RAND and the American Medical Association on physician satisfaction found that of physicians using EHRs, 35 percent responded that EHRs improved job satisfaction. Sixty-one percent of respondents stated that the EHRs improved quality of care.

Most cardiologists can take notes, order prescriptions and track medications via EHR. Systems continue to develop and cardiologists increasingly have lab and imaging results available to them. New features are continually being developed.

However, many physicians have mixed feelings about EHRs. Sure, they can electronically prescribe and take notes, but many complain that electronic records are still little more than paper files: flat, undynamic, unsearchable text. Worse, interoperability and connectivity among specialists, subspecialists, primary care physicians and hospital records remain unavailable unless they’re part of the same healthcare network.

Mixed bag

“We were really quite surprised by the influence of electronic health records on physician professional satisfaction in terms of intensity,” says Mark W. Friedberg, MD, MPP, a natural scientist at RAND and an associate physician at Brigham and Women’s Hospital, both in Boston. Friedberg was one of the minds behind the survey published by RAND in 2013.

Based on survey responses, in some ways physicians found EHRs very useful. “Some typical things we would hear would be, ‘Now I can see all the notes from my practice; not just what I wrote, but what my colleagues wrote from home. When I take a call from a patient I don’t know, I can just look up their records and deliver much better care. I feel more comfortable [and] that improves my professional satisfaction,’” Friedberg says.

However, while physicians responded that the use of EHRs improved their performance in some areas, they also provoked more irritation than adulation. “It’s not like physicians either said, ‘I love my EHR' or ‘I hate my EHR.’ The same physician would be telling us ‘Yeah, it improves my life in this way, but it worsens my life in these other ways.”

This was echoed by the results from CardioSurve. “We’re seeing high levels of installation of electronic medical records and we’re seeing limited positive signals here in terms of, specifically, e-prescribing, electronic medication lists, the availability of lab results,” says John S. Rumsfeld, MD, PhD, the national director of cardiology for the U.S. Veterans Health Administration in Denver. Rumsfeld is part of the leadership behind the ACC’s CardioSurve. The survey found that these positives did not balance what cardiologists disliked about their EHRs.

“What strikes me in reading the results of the survey is how far there is to go for EHRs to fulfill their promise,” Rumsfeld says. “I would say that cardiovascular clinicians strongly support and understand the need for electronic health records, but I would say they largely hate the reality of electronic health records so far.”

The distance between promise and reality fuels part of the negative feeling toward EHRs, Rumsfeld notes. However, there are other factors that affected physicians’ satisfaction with EHRs as well.

When the customer isn’t happy

Unhappy patients had a big impact on physician satisfaction. In both surveys, physicians remarked strongly that EHRs cut into face-time with patients. Physicians spent more time behind the computer during visits, making it harder for them to speak directly to patients and create adequate patient-physician rapport. In a nut shell, “Patients don’t like it either. And physicians know patients don’t like it. No one likes displeasing their patients,” says Rumsfeld.

Douglas Goldberg, MD, a member of the ProHEALTH Care Associates LLP group in Roslyn, N.Y., says, “It detracts from our doctor-patient interaction. We don’t talk to patients anymore. And, half the time that I’m with them, I’m clicking and typing.”

He notes, “It’s adding time.”

Goldberg has been an independent and multipractice cardiologist and is part of the CardioSurve panel. He adds that distracted,