The Most Hated Device in Healthcare Part 3

The Hidden Costs: EHRs and the Rising Burden on Clinicians

In this third post of our series, 'The Most Hated Device in Healthcare,' we dive into the two most important things that make up good software: first, it should relieve the burden of a task, and second, it should be a pleasure to use. With this groundwork laid, we explore why the EHR is hated by many clinicians and the cost associated with clinician burnout.

Relieve the Burden of a Task

There are different types of tasks. Tasks can be categorized as operational, strategic, project-based, routine, ad-hoc, time-sensitive, recurring, and complexity.

For example, if the task requires calculating numbers, such as in accounting, and this task needs to be done repeatedly, then it's a great candidate to utilize automation and remove the effort required to perform the task. The more significant the burden of the task, the more value can be created by creating a solution that can streamline the task.

Excel is an example of one of the most used, if not the most used, software applications. The core ability is to organize and compute the data. The world runs on Excel. Does Excel relieve the burden of a task? Absolutely. Can you imagine creating charts, tables, and calculations on paper?

It Should be a Pleasure to Use

A positive user experience enhances satisfaction, improves productivity, reduces frustration, and increases the likelihood of continued use.

Consumer-based software companies know this all too well. If the user experience is poorly received, the user deletes the application. However, for enterprise software, where your employer or industry dictates that you must use a particular application, you, the user, are more likely to encounter frustrating software. The reason for this is simple: Follow the money. B2B software is stickier than B2C. It's much more expensive and time-consuming for a company to switch all its processes, data, and users to an alternative. Therefore, the company or industry will stay with the software they have, even if it's not great. Thus, enterprise software companies' priorities differ from those of consumer software companies. Enterprise software companies are less worried about losing customers and more focused on introducing new line items to purchase.

There comes a time when an enterprise solution reaches the point where customers decide to "go to market" to look for an alternative. There are multiple reasons as to why an enterprise may reach this point: user satisfaction is too low, pricing is higher than an alternative, quality, stability, and reliability continue to interrupt business, or the direction of the company is unclear. These are all possible reasons why a customer may decide to switch.

The more extensive and complex the software system, the harder it is for customers to switch. Most enterprise software companies' mindset is to create an "okay" level of experience—not great, but just good enough that users can get their tasks done. Unfortunately, "good enough" becomes the expectation that's set.

Why Do Clinicians Hate the EHR

In short, the EHR creates significant barriers to patient care for clinicians. According to the American Medical Association, physicians spend two-thirds of their time at the keyboard, which means that they only spend one-third of their time actually interacting with the patient.

Back to our two-item list of what makes good software: Does the EHR relieve the burden of a task? Yes and no.

For the hospital system as a whole, the answer is yes. It would be hard to imagine a hospital that did not use an EHR. The ability to communicate across departments. The merits of the EHR are huge. The decisions the physician makes about a treatment, are put into action downstream with a click of a button, scheduling, coordinating, billing, regulatory compliance, and on and on.

There is great value in the EHR for the health system, the patient, and the payers. Digitizing the patient record has moved the industry forward. Ironically, clinicians have to spend the most time entering information yet arguably benefit the least. The EHR treats them as data entry clerks, more than clinical experts.

The EHR relieves some burdens but also creates additional work. A clinician can examine a patient's electronic health record and find information to make better decisions. Do users have the time and the skills to navigate the EHR to do this? Maybe not? There are rules in place to catch situations and inform the user. In practice, many systems have many unhelpful alerts that lead to alert fatigue. For example, is it providing value to the physician when they place an order for acetaminophen for a child that the system warns that the patient should not consume alcohol while taking this med? With physician clinical documentation, is the purpose really to lay out a plan of care for the patient or a way to get paid?

Clinicians experience these barriers two-thirds of their shifts every day, which causes frustration. It's a weight they carry with them every day that prevents them from giving the care they want to give. Is the EHR a pleasure for clinicians? I think my points have already been made. How many physicians love the medication reconciliation process? In my experience, none.

My purpose is not to discredit EHRs; it is to highlight that clinicians dislike them because they create a burden.

Going back to our definition of good software, for clinicians, it fails both criteria. It creates as many burdens as it tries to reduce, and it's not a pleasurable user experience.

What Are the Hidden Costs

Let's talk about burnout. I was speaking to an ER physician, and she defined burnout as " the barriers that are in place that prevent me from giving the care I want to give." Most clinicians enter the field of medicine with a mission to help people. When that mission is compromised, it shakes the fundamental reason they are in their profession.

There are multiple reasons for burnout. Lack of autonomy and frustration with the EHR are some of the leading causes.

The consequences of burnout are real. Since 2020, 20% of workers have left healthcare. A severe nursing shortage is causing some hospitals to reduce, or shut down services due to inadequate staff. Although contract nursing is down from a couple of years ago, it is still higher than it used to be. Wait times for a patient to see a physician can be extended due to the need for more physicians. The cost to replace one physician is between $500,000 and $1,000,000.

The Burden Has Been Rising.

The pressure to go faster continues to increase. In recent years, hospitals have experienced reduced margins and higher interest rates. Clinician shortages have increased the demand on the nursing staff, and regulations passed over the decades have focused on improving quality outcomes for the patient but have created additional steps for clinicians.

The ability for patients to send providers inbox messages has increased the confusion among physicians about how to respond to these messages. If a patient sends a physician a message at 5:00 AM stating they have a fever and asking whether they should go to work today, and the physician doesn't see that message until 9:00 AM, is the physician deficit in their response time? Guidelines should be set so that the patient and physician know what should be expected.

Increased regulatory compliance, cognitive overload, alert fatigue (it's worth mentioning twice), reduced patient face time, quality of time with the patient, and continued training or lack thereof on the EHR system that changes a few times a year are just some of the barriers that clinicians encounter every day while trying to take care of their patients.

Conclusion

In conclusion, the evolution of Electronic Health Records (EHRs) from fragmented systems to integrated enterprise solutions has brought significant benefits to the healthcare industry, such as improved communication, coordination, and regulatory compliance. However, these advancements have come at a cost to clinicians, who now spend a substantial portion of their time on administrative tasks rather than patient care. Despite their potential to streamline operations, EHRs often fail to relieve the burden of these tasks and lack the ease of use that characterizes good software, leading to widespread frustration and burnout among healthcare professionals. This dissatisfaction contributes to higher turnover rates and increased operational costs and ultimately impacts the quality of patient care.

Will things turn around? Is there hope that things will get better? Some things are getting better already. In our next blog, we will cover what improvements are being made to the EHR and what the future could look like for clinicians and their interactions with it.

In the meantime, I'd love to hear about your experiences, good or bad, with EHRs!

Chuck Schneider is a thought leader in healthcare tech. He was one of the original architects of a major EHR and has 11 patents. When he is not thinking about healthcare, you can find him outside, engaged in some adventure.