Letters: Failing grade for EHRs shouldn't be a surprise

The article “Physicians score EHRs an F on usability, study finds” stated “electronic health record systems scored in the bottom 9th percentile for technology usability, which could contribute to physician burnout, according to a new study.” These results should come as no surprise to anyone in healthcare.

Not a day goes by in any healthcare setting without hearing from frustrated providers. (I even hear complaints during my office visits with physicians.) EHRs are designed for billing rather than medical usability. They ensure the provider clicks enough boxes to meet criteria for a billing level. The number of clicks and drop-down lists is overwhelming, with the ultimate documentation sometimes worthless. In fairness, ICD-10 further exacerbated this problem with the ridiculous number of sub-diagnoses.

To appease providers, IT has enabled problematic functionality (like copy forward and auto-population of every diagnostic test), further diminishing the value of the patient’s medical record. Reading a record today does not adequately tell the patient story, nor is it user-friendly. I suggest we need to start over with the entire EHR system, utilizing active providers as subject matter experts.

Denise Adema, R.N.
Fort Myers, Fla.

The article “CMS wants primary-care docs to take on financial risk” addresses the CMS’ new direct-contracting alternative payment model, noting, “the pilot will allow providers that deliver evaluation and management services to take on financial risk for original, fee-for-service Medicare patients in exchange for less federal oversight and the opportunity to earn financial rewards. Under the new model, a wide range of organizations can volunteer to accept full or partial risk for managing the care of beneficiaries of traditional Medicare.”

Let’s see. Medicine is also an art; patients are physically unique; patients are emotionally unique; biological systems are still poorly understood; illness can be simply bad luck; socio-economic status is variable. Finally, there is no reasonable expectation that patients will follow advice. And it is suggested that physicians assume more risk. No person with even a modicum of common sense would think this logical in the least.

Dr. Allan Dobzyniak
Sneads Ferry, N.C.

We’ve been paying attention to the wrong statistic in burnout (“Physician burnout rates vary by specialty"). The mean (percentage) burnout rate is not as illuminating as the range.

Having now studied multiple hospital systems we find high variability in the same specialties between systems—in other words, pediatricians at System 1 may be far more likely to be burned out than pediatricians at System 2. Even nurses doing the same jobs on similar units in the same hospitals may have widely different burnout rates.

The problem with attending to the mean is that it suggests that there is something inherent to that specialty that matters. While partially true, it misses the more important take-home—the practice details—which are neither immutable nor unchangeable, matter and can be improved.

Dan Shapiro
Vice dean for faculty 
and administrative affairs
Penn State Health
Principal
Burnout Solutions Group