Digitizing Health Records Can Make Doctors Less Productive

Putting health records in electronic form seems self-evident, but many eye surgeons think it increases their costs and slows their productivity. Pandpstrock001/Shuttestock

There is understandable concern about the privacy implications of the digitization of health records. However, a study of ophthalmologists provides a surprising twist to the belief that information being released is the price we must pay to increase efficiency. Instead, the majority of eye surgeons said digitizing their patients' records has actually made them less productive.

It seems so obvious hardly anyone would question it: electronic records should boost productivity. After all, they can be searched more quickly and accessed from multiple places. Security aside, it would be expected that the only question was whether digitizing existing records, some of which may never be needed again, is worth the effort.

However, when Professor Michele Lim of the University of California, Davis, surveyed a sample of American ophthalmologists, she found this was seldom their experience. Of the 348 who responded to Lim's questions, 72 percent were using Electronic Health Records (EHR) from 2015 to 2016, compared to 47 percent in 2011, she reports in JAMA Ophthalmology.

Nevertheless, respondents reported their net revenues and the number of patients seen a day had declined, which many blamed on EHR adoption. The skeptics also reported their practice costs were higher as a result of EHR use. Although substantial numbers thought EHR had made no significant difference either way, the proportion who thought their practice's revenue had declined outnumbered those who thought it increased by 41 to 9 percent. Meanwhile, 36 percent said it was now harder to provide quality care.

Although the survey did not reveal the reasons behind the problems, Lim notes many doctors complain that features such as drop-down menus mean one click can lead to the wrong information being included.

Disturbingly for those still focused on privacy, 10 percent of doctors who responded did not know whether their patients' data was stored on the premises, on a nearby server, or in the cloud.

The findings were not entirely surprising since a 2011 study found falling rates of satisfaction among those who had adopted EHR at that point.

Lim acknowledges the study only reveals perceptions – it's possible efficiency has risen even while respondents described it as getting worse. Moreover, with only 17 percent of those who were sent surveys responding, the sample may represent a disgruntled minority, rather than a majority view. Nevertheless, it indicates more resistance to EHRs than might be expected, and possibly some deep problems. Since financial incentives have been put in place to encourage EHR adoption, it is questionable whether Medicare, and therefore the US Taxpayer, are getting value for money.

The rate of use of EHRs by ophthalmologists is similar to that of other specialist surgeons in the United States, raising the question of whether digitization is proving a similar burden across all medical fields.

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