January 8, 2018
use of electronic health records (EHR) systems for storing and
accessing patients' medical histories more than doubled between
2006 and 2016, while their perceptions of financial and clinical
productivity following EHR implementation declined, a study
published today in JAMA Ophthalmology shows.
"Our findings highlight the fact that companies that design EHR
systems should further address the efficiency and usability of
those systems," said lead author Michele C. Lim, vice chair and
medical director of the UC Davis Eye Center.
The findings were based on a series of three questionnaire-based
surveys. The most recent survey, conducted from 2015 to 2016,
was emailed to 2,000 randomly selected members of the American
Academy of Ophthalmology. A total of 348 (17.4 percent)
ophthalmologists responded. Similar surveys were conducted in
2011 (492 respondents, or 33 percent) and 2006 (592 respondents,
or 15.6 percent).
Among respondents to the latest survey, 72.1 percent had
implemented EHR, more than triple the rate of 10 years earlier
(19 percent). Ophthalmology practices linked with integrated,
government or university health systems were more likely to have
Respondents who converted from paper to electronic
record-keeping also were asked about productivity changes based
on the number of patients they see each day. Only about 15
percent responded in 2006 that productivity decreased as a
result of EHR adoption, but by 2016 more than half did.
Similarly, respondents were asked how EHR affected overall
practice costs: About 13 percent in 2006 felt that it resulted
in increased costs, compared to 75 percent in the most recent
"The surveys reveal deepening dissatisfaction with utilizing EHR,"
Lim said. "Despite their dissatisfaction, however, only
one-third of ophthalmologists surveyed said that they would
return to paper records if they could, and more than half said
they would not."
The Centers for Medicare & Medicaid Services (CMS) established
incentives in 2011 to encourage hospitals and clinics to adopt
and demonstrate meaningful use of certified EHR technology. At
first, financial rewards were given for EHR adoption. More
recently, financial penalties have been levied for
non-compliance with EHR use.
According to survey results, qualifying for CMS incentives was
deemed cumbersome and too costly by many providers.
authors pointed out that their study was limited by small sample
sizes and the possibility of bias if more dissatisfied
ophthalmologists responded to the two recent surveys or,
conversely, if more satisfied ophthalmologists responded to the
first survey. In addition, the surveys only asked about
perceptions, and the researchers did not validate reported
financial or clinical productivity changes.
Conducting three surveys over time likely lessened these
limitations though, according to Lim. She is planning a future
survey focused on the effects of using medical scribes to aid
doctors in using EHR more efficiently.
"In a perfect world, EHR systems would help providers deliver
efficient patient care and include a positive, user-friendly
interface," Lim said. "EHR technology is evolving, and we will
end up with such systems if appropriate stakeholders, including
health care professionals who use EHR, and those who design them