Understanding EHR Adoption, Use With Medical Specialties

From cardiology, neurology, and behavioral health, EHR adoption, use, and satisfaction vary between medical specialties.

An EHR system does not automatically optimize to each specific medical specialty. In fact, EHR adoption, usability, and satisfaction differ significantly across medical specialties.

According to the most recent Centers for Disease Control and Prevention (CDC) nationwide EHR survey, office-based cardiologists and neurologists have the highest EHR adoption rates by specialty, at 95.6 percent and 94.5 percent, respectively.

Urology (94 percent), general surgery (93.8 percent), orthopedic surgery (93.2 percent), and general/family practice (92.7 percent) have the next highest EHR adoption rates.  

On the other hand, behavioral health providers and psychiatrists have the lowest adoption rate at 61.3 percent. Dermatologists also rank low at 70.2 percent.

EHRs are one of the top clinician burnout drivers, especially among specialists who might need different EHR functions. Health IT experts have said this difference should reflect in EHR implementation and optimization.

EHR Satisfaction Between Specialties

While EHR adoption is almost widespread, EHR satisfaction rates across specialties remain low across the board, according to a recent KLAS specialty EHR satisfaction survey.

Hospital medicine providers proved the most satisfied with their systems, with a 36.5 satisfaction score on a 100-point scale, with pathology (24.3), pediatrics (24), geriatrics (22.9), and family medicine (22.7) also reporting moderate satisfaction.

In other specialties, EHR satisfaction rates were abysmal. Orthopedic respondents had the lone negative satisfaction score (-3.2), with cardiology (1.6), plastic surgery (2.1), and neurosurgery (2.2) also reporting extremely low satisfaction.

The key factor is the quality of initial training, KLAS revealed. The physicians that responded well and showed high satisfaction noted robust initial EHR training for their specialty.

Although specialty training can help decrease functionality issues in the EHR, some specialties do not have the necessary functionality in their EHR, even with enhanced training.

Smaller specialty providers said that the size of the EHR does not match up with the scope of the practice. For example, a dermatologist respondent described the EHR as “overly bulky for outpatient specialty care.”

The EHR also does not support specialty-specific clinical workflows, other provider respondents added.

An ophthalmologist explained how the EHR does not meet the needs of clinicians who “need to be able to document with drawing or images.” Orthopedists have worries with specialty-specific templates, unintuitive user interfaces, and slow response times, the report also noted.

High-quality training and a strong relationship between the organization and the EHR vendor can improve the EHR experience. Organizations that train clinicians how to better use and personalize their EHR can help them gain more confidence using the EHR, leading to higher satisfaction.

Both high and low-scoring specialties are similarly susceptible to the positive effects of training, as well as the negative effects of the lack of proper training, the report stated. No matter the differing issues that certain specialties encounter, organizations can help clinicians improve their EHR satisfaction.

Developing a Specialty-Specific EHR System

Although neurology has a 94 percent EHR adoption rate, researchers at the University of Texas Science Center in Houston optimized a bespoke EHR system around a clinician-centered design that could mitigate specialty-specific clinician burnout.

“Specialty-specific or bespoke EHR is a promising approach to overcoming the limitations of general-purpose EHR and mitigating physician burnout,” explained the study authors. 

“A bespoke EHR is an EHR custom designed to meet the unique needs of providers in a specific specialty or care setting. Bespoke EHR can prevent clinicians from spending a significant portion of their workday sifting through large amounts of clinical data for the specific data elements they need.”

Researchers created the Epilepsy Tracking and optimized Management engine (EpiToMe), a specialty-specific EHR system centered around epilepsy care to evaluate clinician burnout impact.

EpiToMe was not a replacement EHR system for a health system’s parent EHR system. Rather, it was a corresponding solution that leveraged the parent EHR.

The specialty-specific and physician-centered workflow enhanced clinical efficiency for users. 

For example, the average delay time for an EEG report is nearly 15 hours. But when the clinician utilized the bespoke EHR, her respective patients obtained their EEG reports within the same day.

EHR Adoption Trails Behind in Behavioral Health

Although EHR adoption continues to advance across the sector, behavioral health EHR adoption lingers behind its counterparts. According to the ONC Health IT Dashboard, only 49 percent of psychiatric hospitals have certified EHRs than 89 percent of rehabilitation centers, 87 percent of children’s hospitals, and 59 percent of long-term care hospitals.

“EHR adoption lags behind for freestanding psychiatric hospitals because not only do we have the regular conditions of participation to meet with Joint Commission surveys for, but we also have A-Tags, which list most of the conditions of participation,” DeShaun Willingham, regional director of nursing at St. Anthony’s Behavioral Health Hospital, said in an interview with EHRIntelligence.

Being an inpatient facility, having Joint Commission accreditation, being a private-for-profit, or being a public facility are all factors that connect to EHR adoption and use at behavioral healthcare facilities. 

“We have an additional set of rules we have to abide by because we are looking for documentation from social work and how the active treatment program runs,” Willingham said. “Most providers are a one-stop-shop, while freestanding behavioral health EHRs have to be tailored a bit differently.”

Behavioral health EHR developers and hospitals should acknowledge end-user perspectives on specific barriers and facilitators before EHR implementation, according to a recent study featuring survey responses.

For instance, enhanced EHR training and education are essential starting points. Survey respondents echoed Willingham’s response by wanting improved standard practices, such as behavioral health-specific EHR documentation and a seamless mental health workflow into the EHR system.

Willingham also noted that behavioral health facilities are inpatient treatment, but EHR developers key on outpatient treatment.

“The things we require for bedside treatment, especially nursing assessments, have been missing and lagging from EHR systems,” Willingham concluded. “There's the gap in care there, between an EHR and what we do at the bedside.”

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