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Are EMR Complaints Valid?

Physicians consistently have two main complaints regarding electronic medical records (EMRs). The first is that the structure of the system means turning away from the patient, which interferes with therapeutic interactions. The other is that EMRs are cumbersome and negatively impact productivity.

Very little literature is available on either topic. A 2014 study noted that the physician spent less time looking at the patient and, at the same time, the patient stared at the computer screen (Int J Med Inform. 2014;83:225-234). A study of Israeli physicians found that “the computer has become a ‘party’ in the visit that demanded a significant portion of visit time” (Patient Educ Couns. 2006;61:134-141).

A 2013 systematic review concluded with mixed results: While the EMR did impair relationships by reducing eye contact, rapport, and provision of emotional and physician-led patient-centered communication, it also encouraged biomedical questioning of the patient, patient-led questioning, and physician-led information provision (Inform Prim Care. 2013;21:30-39).

Productivity issues seem to occur mainly when the system is introduced into a practice and, over time, tend to disappear to levels near those of paper charts. Another 2014 study found an initial decrease in productivity, volume, and net income when the EMR was implemented, but these returned to pre-implementation levels within 12 months (Health Serv Res. 2014;49:405-420).

Authors of a 2010 study looked at a large academic multispecialty physician group and saw a modest increase in productivity. This appeared to become more pronounced as the physicians gained experience with the EMR (Int J Med Inform. 2010;79:492-500).

There are indications that these results may differ across specialties. A newly published study in Management Science found an initial productivity loss of 25% to 33% (published online July 14, 2014; doi: 10.1287/mnsc.2014.1934). When internal medicine, family, and pediatric practices were compared, internal medicine returned to previous levels within a couple of months. The other two specialties lagged.