EMR: Missed Opportunities and Unfulfilled Promises, Why Patients and Physicians Deserve Better

Fred Baker, MD, FAAFP

The joy derived from meaningful work that positively, and perhaps profoundly, impacts people’s live inspires many to a career in medicine. Unfortunately, much of that joy is infringed upon by some of the execution and design of the electronic medical record, or EMR. According to the American Medical Association, for every one hour spent with the patient, two hours are spent on documentation. Many physicians cite the EMR as a major cause of physician burnout, particularly the often-expressed concern with the rise in perceived overwhelming non-meaningful tasks or workflows. The New England Journal of Medicine noted, “about 80% of physician burnout is really due to workflow issues and, as it turns out, the way the electronic medical records have evolved — unlike in other industries where automation has made work easier — [they] have added work.”

Nowhere is this egregious reality more evident than a scene that plays out in most physician offices, several times a day. A doctor electronically transmits a prescription during a patient visit, then the patient arrives at pharmacy where the pharmacist notes the medication is denied as insurance requires an alternative or preauthorization. Next, the pharmacist calls the physician’s office to request new orders and the physician and their staff must disrupt another patient’s visit, diverting time and resources, as they scramble for a new treatment with no clear direction of what’s available. Additionally, the initial patient must incur a delay in treatment and the added burden of having to return to the pharmacy. How is it possible that — with all the dedicated, highly trained professionals; sophisticated technology, resources and data available in real-time — inefficient and disruptive workflows can be found acceptable? The problem is not a lack of resiliency or desire on the part of the health care professional, rather much of the blame must fall on the two entities most complicit and responsible for the dysfunction — namely EMR vendors and third-party payors, both of whom show no commitment nor priority for minimizing disruption of a therapeutic patient-physician relationship. As many physicians continue to feel overwhelmed, less valued and with far fewer opportunities to pursue the very basic, yet necessary, worklife balance they advocate for their patients, due to poor EMR designs and workflows, we will witness far more physicians retiring early, leaving medicine, cutting back on services, or see far fewer recruits pursue one of the most noble career paths. Corrections are critical to ensure patients have access to high-quality care. Medical societies continue to pursue solutions and they must be relentless in demanding meaningful change. Physician employers could heed the advice that for each 10% drop in task load, it’s estimated physician burnout decreases by 33%. Possibly more impactful, however, is ensuring the public and policymakers hold EMR vendors and third-party payors accountable — demanding all parties explore, share and implement ways to reduce inefficiency.

Frederic Baker, MD, FAAFP is a family medicine attending with UMASS Memorial Community Medical Group Physicians with an ambulatory outpatient practice in Holden. He is a delegate for the Mass Medical Society, a past president of the Worcester District Medical Society and a past president of the Massachusetts Academy of Family Physicians. The views expressed are those of the author and are not intended to reflect nor express the opinions of any particular organization