Adoption of Electronic Health Records and Perceptions of Financial and Clinical Outcomes Among Ophthalmologists in the United States

Abstract

Assessing the rate of electronic health record (EHR) adoption and ophthalmologists' perceptions on financial and clinical productivity is important in understanding how to direct future design and health care policy. OBJECTIVE To assess adoption rate and perceptions of financial and clinical outcomes of EHRs among ophthalmologists in the United States. DESIGN, SETTING, AND PARTICIPANTS Population-based, cross-sectional study. A random sample of 2000 ophthalmologists was generated on the basis of mailing address zip codes from the 2015 American Academy of Ophthalmology US active membership database, which included more than 18 000 ophthalmologists. A survey was sent by email to assess adoption rate of EHRs, perceptions of financial and clinical productivity, and engagement with Medicare and Medicaid programs that incentivize the use of EHRs. The survey was conducted between 2015 and 2016. MAIN OUTCOMES AND MEASURES Adoption rate of EHRs and perceptions of financial and clinical productivity. RESULTS The adoption rate of EHRs among surveyed ophthalmologists (348 respondents) was 72.1%. The responding ophthalmologists perceived that their net revenues and productivity have declined and that practice costs are higher with EHR use. Of those who attested for stage 1 of the EHR incentive program, 83% had already or were planning to attest to stage 2, but 9% had no plans. CONCLUSIONS AND RELEVANCE The adoption of EHRs by ophthalmologists has more than doubled since a 2011 survey and is similar to that of primary care physicians (79%). In comparison with 2 previous surveys of ophthalmologists, respondents had more negative perceptions of EHR productivity outcomes and effect on practice costs, although financial data were not collected in this survey to support these opinions. These negative perceptions suggest that more attention should be placed on improving the efficiency and usability of EHR systems.

Data-Driven Scheduling for Improving Patient Efficiency in Ophthalmology Clinics

“…7,8 As a result, ophthalmologists often report feeling pressured to see more patients to maintain revenue, while having less available time for patient care. [9][10][11] Without approaches to manage these pressures, the situation may become untenable and result in decreased quality of care and physician burnout. 12,13 Reducing clinic inefficiencies can help physicians manage these pressures.…”

<p>Hospital Characteristics Associated with Certified EHR Adoption among US Psychiatric Hospitals</p>

“…A body of studies have addressed concerns about factors associated with the adoption of EHRs among general hospitals, nursing homes, 19,20 office settings, 21 cancer hospitals, 22 critical-access hospitals, 23 obstetrician/gynecologists, 24 and ophthalmologists. 25 Commonly included factors are initial cost of implementing a system, 19,20,23,[26][27][28][29][30][31] maintenance/ ongoing costs, 19,27,30,32 financial incentives, 20,23,24,33 technical support, 19,20,23,26,28,30 privacy concerns, 19,21 perception of hospital staff, 24,28,[31][32][33][34] and workload/workflow change. 20,23,24,26,30,33 Factors concerning facility characteristics have also been mentioned, such as practice setting, 35 teaching status, 36 system affiliation,…”

A Pilot Study on the Effects of Physician Gaze on Patient Satisfaction in the Setting of Electronic Health Records

“…Incentives and mandates within the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, 5,6 have led to the adoption of EHRs as an essential technology for most U.S. medical practices, including ophthalmology practices. 7 While this technology has the potential to increase efficiency and decrease the cost of medical documentation and patient information retrieval, 6 use of EHR has been shown to affect the visual, verbal, and postural connection between internal medicine clinicians and patients. 8 It has also been shown that patients believed exam room computers decreased the amount of interpersonal contact with internal medicine physicians.…”

“…A 2018 survey of the American Academy of Ophthalmology members found that 72% of practices surveyed had implemented EHRs, but found that many ophthalmologists perceived a decrease in patients seen per day and a need for increased EHR usability. 7 These perceptions are warranted as several studies on the efficiency of EHR use for ophthalmologists show that EHR documentation is slower than paper charting. [10][11][12] However, the impact of EHR on the patient-provider relationships needs further investigation.…”