The stress level of most primary care physicians has increased in recent years, and many blame burden from federal regulations, including the meaningful use program, according to a new survey from medical application developer Epocrates.
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The survey of 1,066 primary care physicians indicated that 89% of doctors feel their stress level has increased in recent years, and 43% reported anxiety related to uncertainty surrounding federal regulations.
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The meaningful use EHR regulations were particularly troubling to physicians. One-third of respondents said complying with meaningful use EHR regulations is not worth the long-term effort. Respondents doubt the ability of EHRs to improve clinical quality. They also worry about technology-related administrative burdens and think federal incentives will not cover the cost of EHR adoption.
But physicians do not have a negative view of technology in general. In addition to adopting EHRs at increasing rates, doctors are more likely than ever to use iPads or other tablets. About 25% of doctors use tablet computers in their practice, according to the survey. This marks an increase from 20% in 2011.
"It's interesting, the dichotomy," said Saroj Misra, D.O., program director for family medicine at St. John Providence Health System in Michigan, who responded to the survey. "I think on the one hand physicians are very interested in adopting technology on a personal and individual level, especially for things like information retrieval. But, when it comes to their confidence in the ability of the same type of technology to be applied at a system-wide level, that's where you see a lot of the physician skepticism."
Misra said there are two main reasons why so many doctors continue to bristle at EHR regulations. For one, most practicing physicians are in older age groups that may resist mandates to use technology. Secondly, many doctors have not seen the gains in care quality and efficiency that advocates say will follow EHR implementation.
I think there's a transition period clinicians are going to have to go through and when you're used to doing things your own way, having something imposed upon you is always going to be a problem.
Anne Meneghetti, M.D.,
director of clinical communications, Epocrates
Anne Meneghetti, M.D., director of clinical communications at Epocrates, said the meaningful use rules, as well as other federal health care regulations, have created uncertainty for many physicians. While the industry may have been willing to move toward technology adoption, it was not prepared to advance as quickly as current regulations require. This has created stress for many medical professionals.
"I think there's a transition period clinicians are going to have to go through, and when you're used to doing things your own way, having something imposed upon you is always going to be a problem," Meneghetti said.
She said doctors tend to be early adopters of technology. If something works to improve treatment outcomes or boost efficiency, medical professionals are often the first to advocate for the technology. But some feel that the cost associated with EHR implementation, and the problems a practice may experience if it selects the wrong vendor, make EHRs less of a safe bet at this point.
While some physicians are concerned about too much regulation, strengthening standards for interoperability could actually help many doctors see greater value in the technology, Misra said. His colleagues often say that the inability of different systems to communicate with each other is a significant roadblock that makes the technology less useful. Misra said that government regulators could solve this problem by requiring all EHR systems to comply with a set of standards.
Physicians are embracing the use of medical mobile applications, which have yet to be subjected to federal regulations. According to the survey, about one-half of physicians have recommended apps to their patients. One-quarter do so on a weekly basis. Education apps are the most popular right now. Both Meneghetti and Misra said providing patients with information on their mobile phones can help them understand their condition and take steps to support their health. Additionally, educating patients outside of the office means doctors can spend more time listening to patients during office visits.
Misra said his practice has started recommending apps that allow patients to track symptoms related to their condition and share the data with their doctor. For example, patients with diabetes can record their daily glucose readings, allowing the physician to see how well they are controlling their blood sugar. Misra acknowledged that some doctors have been hesitant to incorporate patient-generated data into their own records, but said that doing so makes sense.
"The truth is we've been doing that for decades," he said. "It's just that the medium has changed. It's not a change in what we're doing; it's a change in how we're doing it."