"The measurement that we are using on satisfaction really reflects what is happening at the site of care and when you have satisfied doctors in working environments, you also have satisfied patients with good health outcomes," she says.
Hoven says it is understandable why most physicians don't want to return to paper records even though they complain about EHR. "It gives me better data at my fingertips in a more timely fashion to manage that patient's care appropriately. That is why we like electronic medical records," she says.
"At the end of the day the electronic medical record is what we need. At the same time it has to be usable and more intuitive; it has to be interoperable; it has to make my work flow easier, not more complicated."
Friedberg rejected suggestions that physicians are simply experiencing "growing pains" as they adapt to EHRs. "I am not sure that fairly reflects the findings of our study and the period of pain both for physicians and for patients may actually be long and something that might deserve a much more serious look," he says. "Certainly it might require quite a bit of explicit effort to address rather than waiting for it to resolve itself on its own."
The survey asked if physician satisfaction improved in practices that had more experience with EHRs.
"We found no relationship there," Friedberg says. "That to us suggests that the opposite may be true, that these issues with EHR are not necessarily an issue of physician familiarity or practice familiarity with the EHR. It really is a fundamental potential issue of the interaction between the state of EHR technology currently and the state of medical practice."
Hoven agreed that "familiarity with EHR isn't really the issue."
"Clearly usability issues, interoperability issues, workflow issues, standards that aren't practice or specialty specific, limitations on what is actually available and in many situations practices have had to actually rip out and replace systems because they simply were not working," she said. "So we still have some huge hurdles to go here to get EHR to where it really works for the physician practice in providing the care that the patient."