Physicians Recognize Pros and Cons of EHR

Edward Melnick, MD, MHS

Physicians recognize the value of the electronic health record (EHR) to patient care, along with the negative associations with patient interactions and work-life integration.

Edward Melnick, MD, MHS, and a team of investigators assessed the associations of perceived EHR usability with patient interaction and work-life integration. The team used a cross-sectional survey to sample 870 practicing US physicians from all specialties represented in the American Medical Association Physician Masterfile from October 2017-March 2018. A subsample of 25% of random responders received an EHR sub-survey.

There were 4 items used to assess the role of EHRs in physician-patient interactions and work-life integration. Of the items, 2 were for perceived benefit and 2 were for perceived disadvantage. Respondents were considered to be satisfied with their EHR’s integration in patient care and home and work life if they indicated “often” or “very often” to the EHR benefit items or “never” or “rarely” for the EHR disadvantage items.

Melnick and the investigators measured perceived EHR usability using the system usability scale, which was a short, reliable usability industry-standard (score range, 0-100; higher scores indicated greater satisfaction with usability). They used multivariable logistic regression to identify characteristics associated with satisfaction with the EHR.

Of the 870 respondents, 40.6% were female with a median age of 53 years old. Nearly 50% of physicians indicated having a computer in the examination room allowed them to share test results with patients often, while 43.9% indicated having a computer in the examination room was often distracting.

Approximately half of the respondents (50.1%) felt having EHR access at home allowed for better care. However, 43.9% felt home access to the EHR had an adverse effect on work-life integration.

The investigators then adjusted for age, sex, hours worked per week, the number of nights on call per week, practice setting, primary care, and marital status. Every additional 1 point higher on the EHR system usability scale score was associated with a higher likelihood of satisfaction with computer use in the examination room to share test results with patients (OR, 1.01; 95% CI, 1-1.02; P <.001) and access to the EHR at home to allow better care (OR, 1.03; 95% CI, 1.02-1.04; P <.001). Every additional point was also linked with a higher likelihood of reporting the computer in the examination room rarely or never distracted them from interacting with patients (OR, 1.04; 95% CI, 1.03-1.05; P <.001) and EHR access at home rarely or never had an adverse effect on work-life integration (OR, 1.02; 95% CI, 1.02-1.03; P <.001).

Overall, the team found physicians recognized the value of the EHR to patient care along with negative associations with patient interactions and work-life integration. The higher a physician perceived EHR usability, the higher levels of perceived positive outcomes like improved patient care and lower levels of perceived negative outcomes like worse patient interaction and work-life integration.

“Better usability and clearer boundaries will likely support therapeutic relationships between physicians and patients and the well-being of the physician workforce,” Melnick and the team concluded.

The study, “Association of Perceived Electronic Health Record Usability With Patient Interactions and Work-Life Integration Among US Physicians,” was published online on JAMA Network Open.