Study Sheds New Light on Physicians' Views of EHRs

Electronic health records are the equivalent of “texting at the dinner table.”

That opinion was common among a group of physicians studied by Brown University researchers. The team analyzed and compared hospital-based and office-based physicians’ views on EHRs. Their work was published this month in the Journal of Innovation in Health Informatics.

“Although hospital-based physicians report benefits ranging from better information access to improved patient education and communication, unintended negative consequences are more frequent themes,” researchers said.

The team included Kimberly D. Pelland of Healthcentric Advisors, Rosa R. Baier of the Center for Long-Term Care Quality and Innovation at Brown University, and Rebekah L. Gardner, of Healthcentric Advisors and the Department of Medicine at Brown University.

These researchers scrutinized physician comments from a 2014 Rhode Island Health Information Technology (HIT) Survey. The 2014 HIT Survey posed the following open-ended question to physicians: “How does using an EHR affect your interaction with patients?”

The study data included 3,561 active physicians licensed in Rhode Island. Physicians practiced in Rhode Island, Connecticut or Massachusetts. Of the surveyed physicians, 68.3% responded.

A qualitative analysis of the data revealed that physicians based in hospitals feel that EHRs have a negative effect on their interactions with patients. These physicians cited reasons for their opinions that differed from physicians who work in offices.

The most common physician complaint, the study noted, is that EHRs take away time that would ordinarily be devoted to patient communication. That means more time typing, eliminating opportunities for eye contact and conversation.

Five major themes emerged from qualitative analysis of the comments. They are as follows:

• EHRs mean less time to spend with patients because more time is required for documentation: This was the most common theme among physicians working in hospitals. “We spend less time at bedside and more time interacting with our computers,” one hospital-based physician said. Office-based physicians tended to make the comment that they spent more time looking at the computer, not the patient, during exams or bedside, researchers say.
• EHRs reduce the quality of the patient-physician interaction and relationship. A sub-theme of decreased eye contact emerged within this theme. One hospital-based physician had this to say: “My nose is now burrowed deep into my computer interface, leaving markedly reduced time to make eye contact and actually interact one on one with my patient.” One office-based physician said that his office interactions were now “like having someone at the dinner table texting rather than paying attention.”
• EHRs have no effect on patient interaction. This theme represented a smaller portion of physicians, researchers said. One hospital-based physician had this to say: “Minimal [effect], as most of my patients are newborn infants. EHR is of some help in communication with patients.”
• EHRs improve access to information, which benefits patient interactions. It wasn’t a completely dour outlook on EHRs. Some hospital-based physicians saw their utility, particularly examining problem lists and lab results. One said, “Helps me with past medical history before I see the patient which is beneficial in the ED.”
• Negative or positive, but non-specific comments. These physicians, researchers say, expressed opinions without context.