Disadvantages of EHR systems - dispelling your fears

Just as the advantages of EHR use has been documented, in an equal measure the disadvantages of EHRs has been widely noted. Before delving into a more in-depth discussion of the possible disadvantages presented by EHRs it is important to note that many of the disadvantages commonly recognized are the product of several factors that are beyond the control of EHR vendors. For example, perceived disadvantages such as lost productivity and burnout or negative financial returns can oftentimes be attributed to a lack of proper training and planning on the part of an organization. However, other circumstances, that can be classified as disadvantages fall squarely at the feet of the vendor due to design flaws.  

Since the adoption of EHRs by healthcare providers began to gain traction over the decade during Obama administration, with the passage of laws to stimulate EHR adoption, there has been discussion and credible evidence of the problems related to EHR adoption. One of the more recent and clear examples of this can be found in a report published by Kaiser Health News and Fortune Magazine. In a joint investigation entitled “Death By 1,000 Clicks: Where Electronic Health Records Went Wrong” the report’s subtitle provides a succinct description of how efforts by the U.S. government, ten years and $36 billion later, to encourage the adoption of EHRs would “make health care better, safer and cheaper.” 

The authors describe the system as “an unholy mess.” The report provides concrete examples of problems related to the efforts to encourage EHR adoption and flaws in these products and how they are used in healthcare practices.  One example of these types of issue can be found in research conducted on attitudes toward EHRs, well over half of the clinicians indicate EHR needs a complete overhaul (59%). A little more than half agree using an EHR detracts from their professional satisfaction (54%). Similar findings indicating dissatisfaction among users was uncovered by a Medical Economics study. The study presented the question if their EHR investment was worth the effort, resources, and cost. A response of “no” was the reply given by nearly 79% of respondents in practices with more than 10 physicians.

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Are these sentiments simply overblown, or can one point to concrete disadvantages related to EHRs? The following provides examples of credible disadvantages related to EHRs and examples of how to mitigate them.  

What are the disadvantages of EHR?

The disadvantages of EHRs relate primarily to a range of factors include user-related issues, financial issues and design flaws that create barriers to using them as an effective tool to deliver healthcare services.  

Lost productivity 

One of the main complaints that resonate across all types of healthcare organizations involve drops in productivity related to EHR use. Productivity drops can arise from several causes. The first and most common relates to productivity drops due to workflow or EHR design that cause clinicians or administrative staff to take more time than normal to accomplish tasks. The second cause of productivity loss relates to insufficient training on the EHR system which commonly arises when new users are introduced to a system or a system is upgraded or changed. 

Research from Stanford Medicine and the Harris Poll documents that EHR-related productivity losses experienced by clinicians can be attributed to design flaws in EHR products whose interfaces are clunky and unintuitive. In the research 72% of survey respondents stated that improving EHRs’ user interfaces would be the most effective way to address EHR challenges. During the selection process, selection teams can focus on this by ensuring a practice selects an EHR whose interface does not disrupt workflows.  

Lack of Interoperability 

Problems related to the interoperability of healthcare data has plagued efforts to modernize the American healthcare system. One of the primary barriers to interoperability rests in the fact that the hundreds of proprietary EHR systems or medical devices on the market do not easily share data. 

Interoperability-related problems rate barriers for providers and patients alike when information such as patient records cannot be shared across settings. Practices can mitigate interoperability-related issues by making this a priority during selection. During the selection process, it is vital to ask vendors if their product is interoperable with other systems. Although it’s not likely a practice will find a fully interoperable system, however, there are products on the market that should offer an acceptable level of interoperability.  

Negative financial consequences

When not properly budgeting for all total costs of operation, miscalculating ROI, or when not properly deployed an EHR project can present a financial burden on a practice.  Evidence of this can be found numerous studies that document EHR-related losses. Survey data from the MPI Group and Medical Economics indicate 65% of respondents reported their EHR systems resulted in financial losses for the practice. A similar study  published in Health Informatics of 39 hospitals found “that increased expenses and slower patient volumes contributed to a median 10.1 percent decline in absolute operating cash flow and 6.1 percent reduction in days cash on hand in the install year.” It is important to note that the hospitals studied were able to rebound from this downturn.   

As referenced above, a strategy to the negative financial effects from EHR projects can be found in proper budgeting and the modeling of costs and benefits. When properly accounting for all financial contingencies, practices can better position themselves to optimize EHR-related benefits and mitigate adverse effects as well.  

Mitigating EHR risk in your practice

The problems outlined above are not ones that lack solutions. Rather healthcare practice can mitigate all these issues if proper measures are put in place. One of the more effective strategies to mitigate these disadvantages involves planning for potential problems early in the implementation phase and by keeping a close eye on how a system performs post-deployment.  The process of planning and monitoring after an EHR has been deployed should include all key stakeholders in a practice and should be carried out with short term and long-term strategic goals in mind.