One of the comments we hear from clinicians who have implemented an EHR is the impact on their after-hours workload, whether this be in the clinic at the end of the day or at home in the evenings. This feedback is not limited to specific EHRs and tends to be a more widespread issue. The following comments were submitted by physicians who completed the AmericanEHR Partners EHR satisfaction survey:
- I can get through my day, but I spend an extra hour to two hours longer at the office than I used to prior to our implementation of the EHR. This is really bothersome to me.
- It makes a 15-minute visit take 2–3 times as long. I’m not sure I’ll ever be able to get back to my pre-EMR volume. Some nights, if I have a meeting after work, I’m up working on charts until 1 am! And that’s only working at 80% of my previous patient volume! There has to be a better way… talk about burnout.
- Radiology reports are now coming across through an interface, but we are unable to see images — for this we must log onto a remote desktop for the hospital in a separate application. I am routinely having to finish charts at home after work.
- I see fewer patients. I spend a few hours at the end of the day finishing entering data. I never had to do this with paper charts.
There are number of potential reasons for challenges with documentation and decreases in efficiency including the following:
- Lack of familiarity with the EHR software and inadequate training. In a survey conducted by AmericanEHR Partners in 2011, (The Correlation of Training Duration with EHR Satisfaction: Implications for Meaningful Use), nearly half (49.3%) of respondents indicated that they received three or fewer days of training. EHRs are complex software applications that require familiarity for efficient use, which should be facilitated by adequate initial and follow-up training.
- Usability problems with the EHR software that require too many clicks in order to perform specific functions or a limited number of mechanisms to enter data into the EHR.
- Poorly designed or deficient templates that slow down the collection of information for specific conditions or types of encounters.
- Inadequate ability to exchange information electronically with other systems (e.g. Labs/Diagnostic imaging) or providers (e.g. Referrals/Consultation reports) resulting in a dual electronic and paper practice process.
What are your experiences using an EHR? Have you returned to or exceeded efficiency levels that you had reached with paper charts? Do you have advice that you can offer other clinicians to improve their efficiency and reduce after-hours workload?