It’s Time for Smarter Electronic Medical Records

In modern, electronic medical records (EMRs) have become ubiquitous, and for good reason. EMRs were initially devised in the 1980s and 1990s to improve quality and efficiency of health care delivery, improving processes that had been in place for decades and aiding both patients and providers.

Today’s EMRs allow providers to have accurate, up-to-date, and complete information, provide quicker access than a physical file, improve security and privacy, improve patient communication, enable safer prescriptions, and even cut costs. These platforms are being developed by technology start-ups, health care organizations, and hospitals, all to improve the way information is gathered, stored, and shared.

However, the mere existence of EMRs as a superior alternative to paper copies of patient records does not make them infallible. Despite the wide- spread use of EMRs, they have not fully lived up to their promise—and in some cases, their use has impaired the effectiveness of care delivery, especially among oncologists and other specialists.

I’ve taken a special interest in EMRs and their effectiveness. In addition to my own use of EMRs and conversations with my peers, I’ve written about the ways EMRs contribute to clinician burn-out and even how it can alert providers when social determinants of health (SDOH) may put patients at more risk.^1,2 My colleagues and I at Cardinal Health embarked on a survey about various trends and critical issues with EMRs in oncology care.

The abstract, which was presented at the 2021 American Society of Clinical Oncology Quality Care Symposium, discussed multiple deterrents that were efficient to use with current EMR systems, as well as essential information in the design of next-generation EMRs that will allow for the incorporation of aspects that are more useful to the end users.³

Looking at the Responses

The objective was to identify barriers perceived by medical oncologists and hematologists in the way they utilize EMR software. The study also aimed to identify the factors associated with levels of satisfaction or dissatisfaction with current software.

We used a web-based survey to gauge satisfaction with current EMR software through a series of questions to physicians. Between January and April 2021, 369 geographically diverse participants from across the United States were invited to complete the survey. Responses were aggregated and analyzed using descriptive statistics.

Overall, 72% practice in a community setting and 47% identified as a hospital employee. Participants had an average 19 years of clinical experience and spend an average of 86% of their working time in direct patient care, seeing an average 17 patients per day on clinic days. Nearly all those surveyed (99%) use an EMR software of some kind at their practice, with Epic (45%) and OncoEMR (16%) being the most common.

Clinician’s Attitudes About EMRs

One of the main goals of the study was to establish the areas in which providers see value and effectiveness with their EMR software and in which areas they struggle or feel burdened by the systems with which they work on daily.

Overall, the study found that most appreciate their EMR software and are satisfied with its performance. At baseline, we asked participants to rank their current EMR software on a scale of “very satisfied” to “very dissatisfied,” and 66% of the participants were either “satisfied” or “very satisfied.” This is important because it indicates that EMRs are valued by clinicians.

We also wanted to investigate what made EMRs effective. When asked what the most useful aspects or features of their EMRs were, overwhelmingly, respondents said the availability of information, such as preloaded protocols, chemotherapy regimens and pathways (64%), and data access (64%). A smaller number of respondents also appreciated the availability of multiple access points, including remote access (37%) and a fast or easily navigated display (27%).

Pain Points Associated With EMRs

The study identified the challenges and frustrations associated with current software. We asked participants what their biggest pain points were with their current EMRs.

Most participants (70%) said the “time-consuming” nature of their current EMR software was their biggest issue. This includes software requiring too many steps, or too many clicks, to achieve its functions. Nearly half of participants (45%) also said interoperability (eg, difficulty sharing information across institutions or other EMR software) was a pain point. A sizable number of respondents also noted the challenges of data entry issues (38%), such as difficulty entering clinical information, scheduling patient visits and reminders, or ordering multiple labs and poor workflow support (31%), which includes missing instructions and issues submitting chemotherapy orders or treatment pathways.

With these results, we can conclude that satisfaction with EMRs is generally positive among those surveyed, but there are multiple deterrents to the efficient use of current EMR systems. This information is essential in the design of a next-generation EMR (an intelligent medical records system) that would incorporate aspects most useful to clinicians, such as pathway access, preloaded information on cancer management, as well as ease of access and portability, and a user experience that minimizes clicks and reduces physician time with EMR.

Why It Matters

Across the board, we know clinicians want to spend more time with patients, but the reality is their time is often consumed with paperwork or documentation, such as EMRs.^4,5 However, we are facing the inflection point.

Last year, I wrote about burnout among community oncologists. For a study published in JCO Oncology Practice, my colleagues and I conducted web-based, paid surveys of US community oncologists/hematologists from September to November 2018.⁶

Physicians were asked about frequency of burnout symptoms, drivers of work-related stress, and their perceptions on management of workload. We found plenty of evidence that proved EMRs could help.

In fact, EMR responsibilities caused moderate to excessive stress at work for 67% of physicians, with 79% of physicians working on EHRs outside of clinic hours. Unfortunately, most oncologists are experiencing burnout symptoms and require additional time beyond what is already allocated to complete their workload.

On top of the burnout, research is increasingly showing that SDOH-related factors affect cancer survivorship⁶ and that physicians need more time and mental space to fully understand not only their patients’ clinical conditions but also their socioeconomic conditions.

What Comes Next?

With the data gathered from this survey, we have a better understanding of what clinicians need and how we can address these issues moving forward.

The next-generation EMRs should be an intelligent medical record rather than just an electronic one. It should incorporate aspects that are most useful for the end users, such as efficiency, access, and availability. Such pain points should be further explored that could result in actionable upgrades to EMR design, leading to improved input processes, interoperability with other software, and ease of data entry.

These innovations could create a user experience that minimizes clicks and reduces physicians’ time using the EMR.

_REFERENCES

_{1. Gajra, A. Recognizing the contributors to burnout among commu- nity oncologists. Physician’s Weekly. June 25, 2020. Accessed Decem- ber 7, 2021. https://bit.ly/31HOyCR}

_{2. Zettler ME, Feinberg BA, Jeune-Smith Y, Gajra A. Impact of social determinants of health on cancer care: a survey of community oncologists. BMJ Open. 2021;11(10):e049259. doi:10.1136/bmjop- en-2021-049259}

_{3. Gajra A, Simons D, Jeune-Smith Y, et al. Physician satisfac- tion with electronic medical records (EMRs): time for an intelligent health record? J Clin Oncol. 2021;39(suppl 28):318. doi:10.1200/ JCO.2020.39.28_suppl.318}

_{4. Jackson C, Lemay MP. Most physicians wish they could spend more time with patients & truly get to know them as people. Ipsos. Septem- ber 20, 2017. Accessed December 7, 2021. https://bit.ly/32YqPyG 5. Cox ML, Farjat AE, Risoli TJ, et al. Documenting or operating: where is time spent in general surgery residency? J Surg Educ. 2018;75(6):e97-e106. doi:10.1016/j.jsurg.2018.10.010}

_{6. Coughlin SS. Social determinants of breast cancer risk, stage, and survival. Breast Cancer Res Treat. 2019;177(3):537-548. doi:10.1007/ s10549-019-05340-7}