March 2, 2021
Most PAs Challenged by Time Invested in EHR Systems
By AAPA Research and Advocacy Departments
PAs often cite Electronic Health Record (EHR) systems as a barrier to work-life balance. Despite many benefits, PAs also view EHRs as a new bureaucratic part of healthcare that causes additional workload for PAs and other medical providers. In fact, more than one in four PAs (26.3%) surveyed by AAPA recently indicated that they spend more than two hours per day outside of their normal office hours documenting clinical care in their EHR system. Further, more than four in five PAs (81.6%) do not have staff support, such as a scribe, to assist in this documentation. With EHR systems the new normal in healthcare, it is important to understand where strengths and weaknesses exist, as well as to identify PA-specific barriers that should be considered and eased.
The Good News about EHRs
Not all opinions are negative when it comes to EHRs, as PAs overwhelmingly agree about several EHR benefits. PAs strongly or somewhat agree that the electronic exchange of information to providers outside of their practice improves their practice’s quality of care (82.6%), increases their practice’s efficiency (77.5%), prevents medication errors (75.0%), enhances care coordination (82.8%), and reduces duplicate test ordering (74.9%). The widespread adoption of EHRs appears to be mitigating some of these very real concerns providers have. Providers also seem to agree that the exchange of EHR information is useful.
The Bad News about EHRs
But current views on the state of EHR systems are not all good. This may be due to technological challenges, with more than two in three PAs (68.3%) noting the difficulty of electronic exchange with providers who are using a different EHR vendor. Other challenges pertain to the patient experience itself. Half (51.3%) of PAs say the amount of time spent documenting clinical care reduces the amount of time spent with patients. There are other logistical barriers for PAs to effectively utilize EHR systems; some of these may stem from the ways in which EHRs are implemented and used.
According to a 2018 AAPA survey of 10 of the top ambulatory and inpatient EHR vendors, while most vendors indicated their software offers full functionality for PAs and makes no distinction in access or use between PAs and other providers, PAs continue to encounter barriers to effective use resulting from the design of the EHR. Three vendors surveyed by AAPA – Epic, Allscripts, and NextGen – may allow a physician to modify a PA’s clinical documentation. More than two in five PAs (41.7%) indicated that they use those EHRs. One in ten PAs (10.1%) indicated that physicians can overwrite their documentation or attribute a PA’s work as his or her own.
Modification of clinical documentation a concern
Modification of a PA’s clinical documentation is a significant compliance concern. A physician’s ability to attribute a PA’s work as his or her own is a potential misuse of EHR technology and increases the risk for fraud and abuse. Hospital and health systems using EHRs that can modify the work of a PA are also at risk of violating Medicare Conditions of Participation, which require assurance of the accuracy, authenticity, and integrity of the medical record. In addition to compliance concerns and potential penalties, the alteration of a PA’s clinical documentation may compromise medical-legal documentation. Finally, EHRs that do not safeguard PA clinical documentation can lead to noncompliance and adversely affect patient care.
AAPA’s EHR Toolkit: Information for PAs and vendors, and resources for talking with employers
EHR Best Practices for EHR Companies: A best practices handout directed at EHR vendors
EHR Talking Points for Employers: A talking points document for discussion with your employer regarding the improvement of an EHR
About the data
Data on EHR usage are derived from the November 2018 AAPA PA Practice Survey, which was fielded to 725 PAs. These data are part of a forthcoming report that will be released on AAPA’s Research Reports webpage.
Vendor-related EHR statistics are derived from a survey of 10 of the top ambulatory and inpatient electronic health record (EHR) vendors. It was fielded in 2018 to assess software design and operability considerations for PAs.
Authors are Tim McCall, PhD and Sondra DePalma, DHSc, PA-C, DFAAPA. Tim is the Research Manager and Sondra is the Director of Regulatory and Professional Practice at AAPA. Contact Tim at [email protected]. Contact Sondra at [email protected]