This is Part 1 of a new series on IT and Physician Satisfaction.

If you ask CIOs and CFOs what their organizational goals are, you will hear about lowering the cost of care, improving quality of care, and improving reimbursement. But, If you watch CIOs and CFOs do their daily routines, you find another answer — they all work to avoid having irritated physicians in their office/meeting complaining about, well, just about anything.   This is just part of the healthcare culture.

Physicians are at the top of the healthcare food chain. They are usually the most highly educated, and expensive single resource in the healthcare process. They are often the largest influencer of the overall cost of care, and their referrals are key to maintaining patient volume, particularly as related to highly compensated procedures. And they are often unhappy with the healthcare IT mandates that have been foisted upon them.

Unfortunately, many recent IT initiatives have placed IT and physicians at opposite sides of the table. Physicians typically are unhappy with IT and its growing role in healthcare. Meaningful Use / MIPS has been a significant factor in physicians’ dissatisfaction with the information technology they are required to use today. Meaningful Use / MIPS is not only the biggest IT –related initiative physicians have ever been affected by; it is the first time many physicians have been required to work with any hospital information systems, except perhaps a dictation system.

The transition away from paper documentation, along with adding CPOE, clinical rules, and workflow templates to physicians’ everyday life has presented physicians with a major – and generally unwelcome — challenge. The RAND Corporation studied physician satisfaction extensively in 2013. The report confirmed that EMR technology has significantly worsened physician satisfaction in many ways. Common physician complaints included poor usability, time-consuming data entry, interference with face-to-face patient care, inefficient and less fulfilling work, and content degradation of clinical documentation. Physicians did not take on their professions expecting these issues, and are not happy. Consider these real-live scenarios where EHRs have impacted physicians negatively, from their perspective:

• A physician may be prevented from ordering medications until the patient’s height and weight are entered into the EMR.   This forces him to hunt down the nurse to get the measuring done before he can proceed, instead of simply writing the order and letting the pharmacy call the nurse to handle the weight question.
• The influx of CPOE has curtailed a physician’s ability to utilize verbal orders, as organizational policies shift toward requiring direct order entries.   Many facilities that do not allow nurses to take verbal orders except when the physician reports that he is not near a computer have experienced physicians abusing that rule by deliberately calling in a verbal order from the bathroom or the cafeteria.
• Physicians complain about how long it now takes to complete their documentation.   Many early studies suggested that EHRs would have significant time impacts on physicians. One early study suggested that an ED physician could spend 2 minutes completing a chart using a template system, 7 minutes for a dictation, or 12-14 minutes using an EMR system.    Not all recent studies bear this out.   For example, a 2005 meta-analysis by Poissant et. al. could not identify a statistically significant trend toward increased or diminished efficiency among more recent studies focused on physician or nurses in hospitals. It’s very clear, however, that documentation time is perceived by physicians as a significant problem.

Physician dissatisfaction with the technology they are using is so serious that, according to Micky Tripathy, CEO of the Massachusetts eHealth Cooperative, one in six providers state that they have plans to change electronic medical records systems in the next year. This is supported by reports from multiple EHR vendors that more than half of their new business is in replacement systems. EHR replacement is a fairly manageable activity for a physician practice, particularly with the proliferation of cloud-based based physician practice systems. However, replacing an EHR is a major expense for a hospital and requires extensive time and resources to complete. In this series of posts, we will examine the topic of physician satisfaction and how IT can influence it for the better.   We will examine such things as:

• Improving EHR usability
• Preventing workflow disruption
• Alarm fatigue
• Service desk support for the clinician
• Physician involvement in IT
• IT leadership for physician satisfaction

We are interested in other ideas that you might want to see included in this series.   Let us know in the comment box below!