ROCHESTER, Minn. — If you've ever felt like your doctor was paying more attention to her computer than your symptoms, chances are it's because the software she is required to click through is among the worst in any industry.
On top of that, the centrality of these cumbersome platforms in guiding the doctor-patient encounter is correlated to physician burnout, a condition literally measured by the degree to which a doctor views your symptoms with detachment.
Those are among the surprising findings in a new study on the relationship between the usability of electronic health records and physician burnout. The study, conducted by a multicenter team from Stanford, Yale, the American Medical Association and Mayo Clinic and published this month in the journal Mayo Clinic Proceedings, surveyed over 5,000 doctors with a questionnaire measuring burnout. It then offered a randomly-selected subset a questionnaire measuring their perceptions of the usability of the software they were made to navigate while managing patient visits.
"What we found in a national sample of physicians is that the electronic health record is really perceived as being not very feasible," says Dr. Liselotte Dyrbye, co-director of the Mayo Clinic Physician Well-Being Program and a coauthor on the paper. "When you compare it to other electronic systems like Word, Excel, Amazon and Google, the electronic health record is really far on the other end of the scale in terms of system usability."
That's putting it mildly. According to a so-called System Usability Scale (SUS) ranking the ease or difficulty consumers report while interacting with different electronic interfaces, the software used by doctors and other health professionals is among the worst of the worst. A 2013 analysis found that on a 100 point scale, your typical Google search posted an SUS of 93, your microwave an 87, your basic interaction with an ATM or an Amazon search scored an 82 and commonly used word-processing software a 76.
EHR software, however, scored a 45. That's in the bottom tenth percentile of all software.
"It's clunky, it's difficult to use, and we found that the physician's rating of the usability of their electronic health record was an independent predictor of their burnout," says Dyrbye. "For physicians who may be in a system where the electronic health record is a little more usable, they have a lower risk of burnout relative to those who are in a system where the electronic health record is perceived as being less usable."
Burnout, for those who may be wondering, has specific components.
"It's this aspect of emotional exhaustion, one in which because of your work, you're emotionally exhausted, you have nothing left to give, and you're totally drained personally." This includes physician "depersonalization or cynicism," a state of mind "that can manifest as being calloused or detached toward patients," she says.
The study could not determine cause and effect. It's possible, in other words, the physicians with burnout naturally hated the screens. But the authors had reason to believe the EHR was integral to burnout, given the fact that physicians in high-burnout specialties tended to rate their EHR's more favorably than those in specialties at lower risk for burnout. The study did not compare different EHR brands, given the wide variability within a given software.
Dyrbye says doctors don't want to be looking at screens instead of patients, much less screens that perform "like a flip phone in an iPhone world."
"No one went into medicine because we want to interact with a computer," she says. "We want to talk to patients and deliver medical care in a meaningful way." Yet studies show that "for every one hour that we as physicians provide face-to-face care for patients, we're spending an additional two hours on electronic health record-related activities." This makes the shortcomings of EHRs all the more toxic for physician morale.
Dyrbye says the problem stems from the fact that EHR's are designed for billing and quality measurement, as opposed to patient care. As a result, the systems often overload clinicians with endless demands for clarifications while neglecting issues that matter to physicians — like easily obtaining records from a patient's visit outside the system. "If it's knee pain, I have to put in left knee pain, separate from right knee pain... my cognitive load goes way up because I'm seeing all this stuff that's not relevant, and I can't find the stuff that is relevant." Clinicians also routinely find themselves in ethical dilemmas, when software demands data they do not possess before they can close out a screen.
"It's not all EHR vendors' fault," she says. "Some of the reasons the system is so inefficient, complicated, complex and poorly usable is because the vendors are trying to comply with different regulations that come out of CMS. In order to get a better system we need simplification of our rules and regulations in the health care field."
All that being said, "I think it is an enormously worrying finding," Dyrbye continued. "This is a tool that we as healthcare professionals rely upon. It's a tool that patients rely on. And its not really living up to its potential. When you have just a couple of companies making EHR's, what is their interest in really investing in a platform that will not only meet billing, coding and documentation requirements, but will help advance care of the patient and reduce the stress on the physician?"