Physician EHR Dissatisfaction Linked to Template Technology

With the majority of US doctors now having used an Electronic Medical Record (EMR/EHR), physician dissatisfaction with EHRs has reached alarming levels.  Major surveys point to a national crisis in EHR usability.  Physicians complain EHRs are difficult in practice and waste valuable time that could be better spent with patients.  Most EHRs, say doctors, have poor user interfaces based on template technology that slow charting down and hurt overall medical quality.  American physicians are angry.

According to surveys conducted by the AMA and Medical Economics, doctor’s dissatisfaction is linked to poor usability stemming from template based EHRs.  87% of physicians who use EHR systems claim usability issues as their primary complaint, and 92% of practices describe their current EHR as “clunky” and/or “difficult to use.”  A full 96% agree that their practice will never again achieve pre-EHR productivity levels if they continue with their current EHR.  A survey by American College of Physicians (ACP) found that every respondent reported losing some time each day because of EHR use.  Physicians blame template EHRs for losses in productivity, bedside manner, and medical quality.

The 2009 High-tech Act earmarked 3.9 billing dollars for Healthcare IT modernization.  Rewards in the form of financial incentives from Medicare have been the driving force behind the Meaningful Use (MU) certification, intended to encourage nationwide Electronic Medical Records adoption.  “Enhanced oversight, combined with potential cost efficiencies and quality-of-care improvements, have led to the federal government’s carrot-and-stick approach to EHR adoption,” says Medical Economics.

Over the past 5 years alone, hundreds of vendors have entered the market in a massive rush to sell EHR systems to physicians.  The majority of these companies are actually medical billing companies with no experience in clinical charting.  However, adding a template EMR along with billing services puts these companies in-line for the federal incentive payments designed for EMR adoption.  Medical billing and insurance companies alike have moved rapidly to market template EHRs.  In general, template technology is easy to develop from a technical standpoint yet difficult to utilize in practice.

Also contributing to the poor usability of template systems has been the rush to design and certify such systems for Meaningful Use.  The Centers for Medicare and Medicaid (CMS) set stringent deadlines for EMR vendors certify for MU Stage 2 by January 1st of this year.  This led most vendors to hurry EHR development opting for expediency over quality.  Product certification was seen as more important than product functionality.  As a result, Meaningful Use Stage 2 has been an unmitigated failure.  The attestation numbers speak for themselves.  With 147 certified EMR vendors certified, only 50 physicians in the entire United States were able to successfully attest for Stage 2 by May, 2014.  Finally, when only 2,700 had attested by August, 2014, CMS relented and allowed the attestation timeframe to be pushed back.

The dismal MU Stage 2 attestation figures reveal important lessons for the EHR industry:

First, it may be easy for an template EMR to pass Meaningful Use certification.  However, developing an EHR that helps physicians practice better medicine while achieving MU attestation is a different matter.  EHR systems that were rushed to meet arbitrary Meaningful Use timelines have proved unusable.  Unrealistic deadlines have led to awkward, difficult-to-use technology that slows down the work of practicing physicians.  Healthcare technology is too important to be rushed.  Likewise, the practice of medicine is too serious to be manipulated with carrots and sticks.  Certifying an EHR that helps (and not hurts) doctors cannot be accomplished under arbitrary Meaningful Use guidelines.  Physicians are now bearing the burden of a poorly planned federal certification program.

Second, template technology itself, although easy and inexpensive to develop, has proven problematic in clinical settings.  Most physicians site systemic issues in the rigid template user-interface.  “Template-based notes degrade the quality of clinical documentation”, reports the Huffington Post.   Doctors “described template-based notes as a significant threat to both clinical quality and professional satisfaction.  Such notes were described as complicating the task of retrieving useful clinical information. This problem was reported by physicians in all specialties and practice models included in the study.”

Physicians also argue that the fundamental premise of the Meaningful Use program is flawed.  Like any technology, the best way to push implementation is to create a user-friendly product that helps speed efficiency. Template EHRs take physician attention away from patients, thereby reducing productivity,” reports, Medical Economics.  What’s worse is that templates force the user to follow a preset format as they see patients.   The problem is that no two patients are the same and no two physicians are alike.  As a result, template EHRs slow physicians down, degrade medical quality and in general do not perform well in real life clinical settings.

As losses in physician productivity and medical quality mount, serious legal implications of extended template EHR usage are surfacing as well.  Template EHRs open physicians up to increased malpractice threats while their use in clinical settings is being labeled a “patient safety-risk”.  In a recent medical malpractice lawsuit in New York, the court succinctly placed the liability issue in the case on the use of templates in the physician’s EHR.  The doctor indicated that she had no option regarding the use of a template: ‘you have to choose a template,’ and by that choice, a screen pops up and provides the doctor with other options or choices to make’.  The template limited the entry of information and differential diagnosis choices and the results were catastrophic.

As 2017 is underway, most US physicians are either struggling to adapt their rigid template EHR systems to function in real-world clinical settings or 2) replacing their template EHRs with systems not based on inflexible template technology such as more flexible and adaptable “template-free” EHRs.

Systems free of structured templates are proving to be a solution to slow and poor quality charting.  Praxis EMR, an award winning system with artificial intelligence (AI), is a popular example of one such template-free EHR.  Instead of forcing a physician to follow preset templates, Praxis EMR learn from its user.  This allows a physician to practice faster and higher quality medicine than is possible with template technology.   Physician’s report time savings of 2-3 hours a day, improved documentation and medical quality, and lower workplace stress levels after using Praxis EMR.  To see how Praxis EMR works, please visit: