PracticalDermatology

New numbers from a Medscape survey that were reported by Kaiser Health News show that 62 percent of EHR users are happy with their system¹. While this constitutes a healthy majority, equally noteworthy is the percentage of respondents who are not only unhappy with their EHR, but also likely to not switch systems for having invested too much already. Twenty- eight percent of all physicians surveyed indicated that they would not switch, as opposed to just 10 percent who are unhappy and will switch.

As with any survey, the phrasing of the question is arguably of equal importance to the responses. And in this case, the use of the word “happy” is particularly curious. What does it mean to be happy with an EHR? To be sure, with ongoing issues and changes to the HHS incentive program coupled with the practical issues of transitioning a paper practice to electronic records, a certain amount of frustration is perhaps inevitable. Nevertheless, that such a large percentage of “unhappy” respondents will not be changing EHR systems perhaps speaks to a level of acceptance that many physicians have achieved in recent years. It also sums up the current moment with EHRs, which is perhaps better defined by inevitability than new horizons.

The rise of EHRs may not be occurring at the rate many of us expected, but they represent the future of healthcare just the same. The purported reason for this is that younger clinicians who are more tech-savvy and friendlier to digital endeavors will be more accustomed to EHRs as playing a critical role in medicine. In other words, they have come up in an age of computers and therefore will likely find the transition to a digital world of medicine fairly smooth. Older physicians, however, are not taking to the shift as easily. And while the government penalties for not adopting EHRs might appear significant, they may not be enough to convince many paper-based physicians to upend their way of working and practicing medicine. Thus, no matter how much the government tries to incentivize doctors to make the switch, the broader shift to EHRs in this country will be a gradual process, one that has evidently been marred by frustration.

I have noted in previous articles the changes that have been made to the government incentive program. And while it appears now a steadier course may be ahead on the regulatory front, an arguably shakier component of EHRs in our specialty concerns the companies themselves. Inevitably, the business aspects of our specialty and in healthcare in general will greatly impact the direction of EHR manufacturers. Over the next several years, we will learn which manufacturers emerge as the top providers in the broader field of medicine. Once this happens, these larger providers will likely acquire the more successful specialty-based manufacturers. In 10 years, the EHR land- scape may be vastly different due to consolidation, which can make the selection of an EHR right now even more burdensome.

CONDITIONS OF SATISFACTION

Whether the government or manufacturers can make the changes necessary to increase user happiness with EHRs remains to be seen. It is very likely that this curve follows a similar trajectory as that of EHRs users. As older physicians retire, younger physicians reared on digital technology will more naturally adapt to them. It is also highly likely that younger, tech-savvy physicians will have greater expectations for EHR quality and usability. In fact, these physicians are going to play an integral role in redesigning these systems to “think” more like a doctor does.

If you are going to take the plunge this year or if you have already implemented an EHR in practice, it is best to perhaps approach EHRs as a matter of what “works.” It isn’t possible to know what kind of dips and turns are ahead for a given EHR company or for EHRs in general, but the best way to determine what works for you is to do your due diligence, watch systems in real time, and make the best determination of how a given system suits your own flow.

EHRs will never suit the needs and desires of those who want them to approximate the old ways of doing things. But now that they are playing a legitimately larger role in the practice of medicine, they are going to be wired into our education and communication as well as our practices. That is why this changeover is inevitably slow, and that is why in 2013 clinicians are better to think in shrewder terms when it comes to investing in EHRs: such as which EHR hinders you the least, or which one seems to have the most upside for growth. As time goes on, we can only hope that the conditions of satisfaction will change and that EHRs will become more embedded into our work flows and practice foundations. But as we begin another year and the digitization of medicine continues to slowly evolve, the right question is not whether we are “happy” with our EHRs, but whether we can live with them.

Mark Kaufmann, MD is co-chair of the Dermatology work-group for CCHIT. He is on the Medical Advisory Board of Modernizing Medicine.

1. Reese S. EHRs: Which Ones Doctors Like and How Their Lives Changed. Medscape Business of Medicine. August 23, 2012.