The number of ophthalmologists who have adopted electronic health records (EHR) since 2011 has significantly increased, according to a survey-based study.
Surveys were emailed to 2,000 members of the American Academy of Ophthalmology from 2015 to 2016, and 348 (17.4%) responded. Of those survey respondents, 251 (72.1%) had implemented EHR for some or all physicians in their practice, versus 47% and 19% in similar surveys in 2011 and 2006, respectively, reported Michele C. Lim, MD, of the University of California Davis, and colleagues.
However, in comparison with previous surveys, ophthalmologists’ perceptions of financial cost to their practice and clinical productivity have become increasingly negative, they wrote in JAMA Ophthalmology. Lim’s group found that perceptions of overall efficiency and practice costs associated with EHR adoption have changed since the original 2006 survey.
The 2016 survey found that more than 50% of survey respondents perceived that productivity (the number of patients seen per day) had decreased since the adoption of EHR, compared with slightly more than 10% in 2006.
And more than 70% of 2016 survey respondents perceived that their overall practice costs increased after the adoption of EHR, compared with slightly more than 10% in 2006.
Lim’s group noted that these negative perceptions about costs and productivity persisted, despite a series of studies of ophthalmology practices demonstrating that neither practice revenue nor productivity showed significant differences after after EHR adoption.
As for the use of EHR in clinical practice, about two-thirds of respondents in the 2016 survey reported they were using the computer for clinical documentation versus just one-third of respondents in 2011. The greatest changes in computerization were for functions directly related to patient care, including e-prescribing, image management, and clinical documentation.
When asked about their level of satisfaction with image clinical documentation systems, 50% of respondents said they were satisfied with their clinical documentation system, and 49% said they were either satisfied or extremely satisfied with their imaging management system. About one-quarter (27%) of respondents were dissatisfied with their clinical documentation system, while 16% were unsatisfied or extremely unsatisfied with their image management system.
The authors also found that while the vast majority of ophthalmologists were engaged in federal EHR incentive programs (83% had already or were planning to attest to stage 1 and 2 of meaningful use), “the cost and complexity of the programs are potential barriers to participation, and this emphasizes the need to simplify measures that are a part of the new Advancing Care Information program that is the successor to meaningful use.”
Study limitations included the fact that some of the opinions addressed in the 2016 survey were more negative than in previous surveys “and it is possible that those who responded to the survey were more likely to have negative opinions of the EHR or that early, more enthusiastic adopters were more likely to have been included in the 2006 EHR survey and that this may account for the shift in opinions.”
They also stressed that negative responses to questions about financial performance were “opinion only” and not accompanied by actual financial data.
The authors concluded that ophthalmologists’ negative perceptions of the costs and productivity outcomes associated with EHR adoption “suggests that more attention should be placed on improving the efficiency and usability of EHR systems.”
In an invited commentary, Jennifer S. Weizer, MD, of Kellogg Eye Center at the University of Michigan in Ann Arbor, and colleagues wrote that the finding “illustrates the significant opportunities to create a better, more cohesive EHR system that includes integrated clinical and image documentation.”
Weizer’s group suggested that the opportunity to create value through EHR lies in its ability to facilitate the move towards precision medicine and that success in overcoming the technical barriers still associated with EHR “will catalyze true value in exchange for the time, resources, and energy being invested in EHR.”
They added that realizing this true value — and ultimately improving patient outcomes — is likely “an unappreciated and important” reason behind why ophthalmologists want to stick with EHR despite some of the problems pointed out in the study results.
The study was funded by the American Academy of Ophthalmology.
Lim disclosed no relevant relationships with industry. One co-author disclosed support from the NIH, the National Science Foundation, and Research to Prevent Blindness, as well a relevant relationship with Novartis. One co-author disclosed support from Alcon Labs.
Weizer and co-authors disclosed no relevant relationships with industry.
Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner