The current reality of EHRs isn’t as inspiring. As a starting point, The Harris Poll conducted a survey on behalf of Stanford Medicine that explores the attitudes physicians have about EHRs in their practices. The online survey took place between March 2 and March 27, 2018. Respondents were 521 primary care physicians in the United States, whose medical specialty was defined as Family Practice, General Practice or Internal Medicine, recruited through the American Medical Association lists. Results were weighted to bring gender, region, and medical specialty into line with actual proportions of doctors in the country. They were licensed to practice in the U.S. and had been using their current EHR system for at least one month. When EHRs were first introduced, the hope was that they would liberate patient health information and would lead to better insights and care. But primary care doctors are clear in the survey and in conversation that the opposite has happened: EHRs too often get in the way of better care. In the Stanford Medicine-Harris poll, doctors report that more than 60 percent of their time spent on behalf of patients is actually devoted to interacting with EHRs. Half of the office-based primary care physicians think using an EHR actually detracts from their clinical effectiveness, writes Verghese: “In America today, the patient in the hospital bed is just the icon, a placeholder for the real patient who is not in the bed but in the computer. That virtual entity gets all our attention.”

Christine Sinsky, MD, Vice President of the American Medical Association in charge of professional satisfaction, says that these results accurately reflect her experience as a physician.

“If anything, they underestimate the degree of professional angst and moral distress that physicians have experienced as they deal with this tool.”

The angst comes when physicians have to make trade-offs between the amount of time they spend with their patients, the amount of time they spend creating documentation of their encounter with each patient, and the amount of time they have left for families and friends.

Physicians in their practice have to synthesize a great deal of information, and EHRs often make this task more difficult, says Sinsky. EHRs are often designed with dropdown menus that increase the cognitive workload on the physician. Doctors report anecdotally being able to see fewer patients, having to spend more time working and feeling dissatisfaction with the work they do. Whereas previously a physician might dictate a brief medical note, they are now often responsible for the clerical work of formatting electronic notes, which increases the time spent on documentation. Medicare and Medicaid reporting requirements have made this problem worse by requiring physicians to document every action taken on behalf of the patient. “As good as the EHRs are as they exist right now, they’re not nearly as intuitive as they should be,” says Marc Harrison, MD, President, and CEO of Intermountain Healthcare.

“They actually can get in the way of the patient-doctor interaction. As a nation, we are taking our doctors and nurses and making them into data-entry clerks. It’s not fun, it contributes to burnout, it’s non-value-added time.”

Few physicians see any clinical value in their EHRs. Only 8 percent cite factors related to clinical matters, such as disease prevention and management (3 percent), clinical decision support (3 percent), and patient engagement (2 percent). On the other hand, 44 percent of physicians say the primary value of EHRs is to serve as digital storage. Where do we go from here? Nearly three-quarters of doctors in the poll say the first order of business should be improving the user interface of EHRs to enhance efficiency and reduce screen time. Half want to see data entry shifted to support staff and 38 percent would welcome a highly accurate voice recording technology that would act as a scribe during patient visits.