Electronic health records (EHR) have the potential to greatly improve the quality of care. EHRs allow multi-specialty teams to access the same underlying medical information and eliminate the issue of miscommunication due to poor physician hand writing. At the same time, EHR increase data entry burden. Is the benefit of EHR worth the cost?
One key challenge here is that the costs of EHR–beyond the monetary cost–are not well known (to be honest, the benefits are also difficult to quantify . Using EHR data and a survey from physicians at the Palo Alto Medical Foundation (PAMF), a paper by Tai-Seale et al. (2019) found that:
…in-basket messages generated by the EHR system accounted for almost half (114) of the 243 weekly in-basket messages received per physician, on average—far exceeding the numbers received from their colleagues (53) and patients (30). In a survey, 36 percent of the physicians reported burnout symptoms, and 29 percent intended to reduce their clinical work time in the upcoming year. Receiving more than the average number of system-generated in-basket messages was associated with 40 percent higher probability of burnout and 38 percent higher probability of intending to reduce clinical work time.
Designers of EHR will need to increasingly take into account the cost of alerts. For each individual alert, the benefits probably outweigh the cost. However, as the number of alerts increases, the cost to physicians–in terms of psychic burnout–increases in a non-linear fashion. Thus, alert optimization is an area where EHR need to significantly improve to be able to balance physician quality of life with patient quality of care.
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