Making Electronic Health Records Work Better for Patient Care

The promise of the electronic health record (EHR) has always been that it will make the health care system work better for patient care—physicians will communicate more effectively across sites of care, tests will not need to be redone because laboratory results and radiographic images will be readily available, and patients will have access to and ownership of their records. Unfortunately, we are far from this promise and now also grapple with the unintended consequences of EHRs. For instance, there is a loss in personal connection when a physician faces the computer screen instead of the patient. Another consequence is the way in which electronic “paperwork” has burdened physicians and reduced the time available for patient care, stories of which are common in the popular press.^1,2

In this issue of JAMA Internal Medicine, Murphy and colleagues³ quantify 1 aspect of this burden—the inbox notification. When Murphy and colleagues totaled the number of notifications sent to ambulatory-based physicians at 3 different sites (using 2 different EHRs) regarding patients’ test results, responses regarding clinic referrals, requests for medication refills, and messages from other clinicians, they found that the average primary care physician received nearly 77 notifications daily and specialists received nearly 30. Given that it takes approximately 1 minute to manage each notification, the average primary care physician is spending more than 1 hour each day, uncompensated, handling these electronic communications, positioned at the computer instead of facing the patient. Although many of these notifications are in the service of patients, we need to be sure that physicians’ reimbursement, particularly for primary care physicians, is taking into account the full time needed to manage patients’ care. Moreover, inbox notification capabilities should be periodically reviewed to be sure that this component of the EHR is working in the best interests of patient care and not creating an unnecessary burden on physicians.