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Dr. Sara Pastoor: It’s time to evolve how we measure the success of EHRs to make us healthier

A version of this article recently appeared on 

We’ve known for the last decade that electronic health records (EHRs) have a significant impact on physicians’ ability to deliver high-value care. It not only has a largely negative influence on their quality of life, which bleeds over into the entire health care landscape, but also impacts their ability to successfully adapt practices to evolving payment models intended to improve patient health outcomes — especially important for primary care.

Yet despite the clear need for transformation, most EHRs haven’t changed very much. Here’s what a few recent studies tell us about the need to evolve EHRs and how a shift in the way we define success could have a massive impact.

The burnout problem

Study after study has cited that the time clinicians spend in EHRs battling poor design, combined with other workplace stressors, add up to significant burden and burnout. Not only is this impacting individuals, but it is affecting the entire health care landscape. In fact, it is one of the driving reasons behind the worker strike at Kaiser Permanente, the largest health care strike in U.S. history.

In addition, high-value care delivery within the framework of traditional EHR systems isn’t making physician lives — and patient focus — any easier. In fact, as many health care professionals know from painful personal experience, most traditional EHRs make the process even more difficult, requiring workarounds, disparate systems, clunky workflows, and additional documentation and processes. This is especially true for practices undergoing the slow migration from fee-for-service (FFS) to alternative payment models (APMs), operating simultaneously in both business models for years. The resulting effect is even more administrative burden and stress, adding to a world in which the transition from FFS to value-based payment models (VBP) seems insurmountable.

A call for change

EHRs have an enormous impact on physician well-being. So the question remains if there is so much useful data telling us that clinicians are burning out and struggling to adapt to payment models that help improve patient outcomes, shouldn’t addressing these challenges be one of the main ways we health care experts measure our success as an industry?

Most EHR key performance indicators reference measures such as data quality, safety, revenue cycles, billing, and productivity. Yet these factors don’t take into account the sentiment and personal impact to the individual clinician, operational inefficiencies, or payment model transformation efforts.

To explore how my own employer, an EHR technology company powering innovation in primary care, affects users’ experience of administrative burden and burnout, the company recently surveyed customers to gain a holistic view of its EHR’s impact on clinicians’ quality of life. 32 percent of providers decreased their time spent on administrative tasks, and 42 percent said their stress/burnout had decreased. These data point to the fact that a clinical-first approach to EHR design can have a positive impact on administrative burden. The survey also illustrated what exactly is contributing to EHR-related administrative burden and burnout more broadly: Documentation burden played a starring role, with supporting roles from prior authorizations, schedule management, coding/claims/billing, and care between visits.

Another independent study conducted by the American Academy of Family Physicians (AAFP) Innovation Lab found that mature adoption of alternative payment models has a direct, positive effect on physician burnout. In fact, the study showed that for physicians who had 75 percent or more revenue from prospective payments (capitation), they experienced little to no burnout. As an industry, we can no longer continue to ignore the obvious impact EHRs have to enable transformation and a sustainable quality of life, especially for primary care physicians.

A new way to measure EHR success

While physicians live in EHRs day in and day out, they are powerless to independently enact the changes they’d like to see in the technology they use. That’s why we continue challenging ourselves and other EHR vendors to expand success measures to include administrative burden and burnout as a way to drive meaningful change. Conversations to develop this new measurement system should include:

  • Evaluating and monitoring physician experiences and sentiment;
  • Measuring specific contributors of burnout;
  • Understanding where time is most spent;
  • Measuring impact to time spent with patients;
  • Minimizing the number and repetitiveness of tasks;
  • Improving system integrations; and
  • Advanced solutions for adaptation to APMs and VBP.

EHR buyers, technology analysts, and evaluators (e.g., KLAS and Gartner) all can help accelerate this change by evaluating the success of EHRs based on their ability to drive down administrative burden and stress and fully support successful value-based payment models.

No longer can we ask physicians and their teams to bear the burden of delivering the care, shouldering the additional administrative work, and risking their personal well-being and financial stability to do so. We urgently need technology that is purpose-built to facilitate success for the benefit of our physicians and health care system. It is beyond time for EHR vendors to hold themselves accountable for supporting the growing innovation in care delivery models to produce healthier outcomes.

Sara J. Pastoor, MD, MHA is Elation's Senior Director of Primary Care Advancement and leader in primary care advocacy. Dr. Pastoor is a board certified and clinically active family medicine physician. Her experience as a primary care innovator spans a career in military medicine, academic medicine, private practice, and employer-sponsored delivery models. She received her MD from Rosalind Franklin University of Health Sciences and MHA from Trinity University.