The BC Ministry of Health has committed to digitizing the health care system. In 2016, the Island Health Authority pioneered Cerner at Nanaimo Regional General Hospital (NRGH), transitioning from paper-based to digital systems, where clinicians could enter electronic orders and notes accessible across different settings.[1] Starting in 2018, Cerner was rolled out in phases in the Vancouver Coastal Health Authority and Provincial Health Service Authority, and Meditech Expanse adoption continued in the Fraser Health Authority and Interior Health Authority. While the public believes that electronic health records (EHR) can improve the quality of care, physicians have expressed their concerns, and evidence suggests serious drawbacks.

Shifting administrative tasks to physicians

Eighteen months after the implementation of Cerner at NRGH, 72% of physicians reported decreased productivity, and 61% acknowledged improving EHR proficiency.[1] The answer to this apparent paradox: task shifting from administrative staff to physicians.

Since hospitals eliminated transcription services, physicians now dictate or type reports. Dictation software does not accurately recognize physicians’ accents or patient names that are not Euro-centric. Administrative workloads increase for physicians, who spend time correcting dictation errors or resort to typing.

Increasing cognitive workload to enter orders and access data

EHR workflows are inflexible and user-unfriendly when EHRs standardize data entry. Being unfamiliar with user manuals or EHR updates can result in inefficiencies (e.g., it can take more than 1 hour to order a rare diet).

The phased implementation since 2016 has resulted in various versions of the EHRs coexisting within one hospital. Physicians must compile information from all versions to optimize patient care when seeing patients followed by clinics at different implementation stages. This demands significant time and memory capacity.

Increasing complexity to navigate incomplete and fragmented patient data

CareConnect is the platform that pools provincial EHR data. However, the data linkage remains incomplete. Document types that can be linked vary among health authorities, and sensitive data is inaccessible due to privacy rules. The lack of a robust search tool and meaningful data merge complicate clinicians’ navigation process. When data are missing or unidentifiable to physicians, patients are at a higher risk of misdiagnosis and delayed care.[2]

Increasing workload to adopt and use EHR

Physicians and trainees working in more than one health authority must train in various EHR platforms, which poses challenges for those who are not tech proficient. Additionally, a physician clicks an average of 4000 times during a 10-hour emergency room shift, which equates to 66 minutes dedicated solely to clicking.[3]

EHR’s impacts on patients and physicians

EHRs impact patient care. Patients cannot access timely care when administrative tasks consume physicians’ time or force them into early retirement.[4] The quality of patient care is threatened when EHR data are missing or unmeaningfully merged[2,4] and physicians are exhausted with administrative tasks.[5]

EHRs are here to stay, so the crucial question is: How can we enhance EHR systems to better support physicians? It is imperative to conduct research and quality improvement projects to identify sustainable solutions.
—Olivia L. Tseng, MD, PhD, CCFP, FCFP
Vancouver
—Esther Lee, MD, MCS, FRCPC
Vancouver

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References

1.    BC Ministry of Health, Ernst and Young, Island Health. Review of Island Health’s IHealth electronic health record system. 2017. Accessed 16 August 2024.

2.    Getzen E, Ungar L, Mowery D, et al. Mining for equitable health: Assessing the impact of missing data in electronic health records. J Biomed Inform 2023;139:104269.

3.    Hill RG Jr., Sears LM, Melanson SW. 4000 clicks: A productivity analysis of electronic medical records in a community hospital ED. Am J Emerg Med 2013;31:1591-1594.

4.    Loria K. Physicians leaving profession over EHRs. Medical Economics. 24 January 2018. Accessed 4 June 2024. www.medicaleconomics.com/view/physicians-leaving-profession-over-ehrs.

5.    Alobayli F, O’Connor S, Holloway A, Cresswell K. Electronic health record stress and burnout among clinicians in hospital settings: A systematic review. Digit Health 2023;9:20552076231220241.