Significant Dissatisfaction and Barriers Exist in the Electronic Health Record Management of Patients With Inflammatory Bowel Disease

Background:
Electronic health records (EHRs) were designed to improve the efficiency and quality of patient care. However, EHRs have become a source of significant burden related to the extensive documentation, billing, and messaging, leading to increased patient care time. Clinicians who treat patients with chronic disease such as Inflammatory bowel disease (IBD) are prone to EHR-related burnout. The aim of this survey study is to explore current EHR practices at IBD programs across the United States.
Methods:
We conducted a survey study using Research Electronic Data Capture (REDCap) targeting IBD physicians at leading IBD programs throughout the United States. The survey included questions on demographics, IBD center characteristics, EHR type and satisfaction, EHR enhancements, and IBD-specific optimization tools. Surveys were distributed via email to IBD directors, who were asked to share the survey with their IBD colleagues.
Results:
Surveys were sent to 65 IBD programs, with 43 survey responses collected, including 5 from non-physician providers. Respondents had a median age of 47 years (IQR 41-53), 51.2% female. Most providers (90.2%) were from academic centers predominantly located in the Southeast (48.8%), Midwest (22%), and Northeast (14.6%). Of these, 28 (68.3%) providers have leadership roles within their IBD program. Epic (Madison, WI) was the predominant EHR system (93%). All providers (100%) believe there are opportunities for EHR improvement in the care of IBD patients. Nineteen (46.5%) providers stated EHR does not enhance IBD patient care, 29 (69%) have tried to build EHR enhancements, 16 (37%) have a provider designated for improvements, and 31 (74%) do not have access to a health information technology (IT) specialist. Primary factors of EHR dissatisfaction include amount of time in EHR (87.8%), in-basket message volume (82.9%), and documentation (63.4%). Thirty-seven (86%) felt that their EHRs does not adapt to IBD treatments or guidelines. The most frequently used IBD-specific EHR tools are smartphrases (90.5%), note templates (71.4%), and order preference lists (66.7%). Of the 11 possible IBD tools listed in the survey, 23% providers were using 3 tools or less. The least common tools used are synopsis (16.7%), snapshot (16.7%), and registries (21.4%). Providers were most interested in obtaining patient reported outcomes (58.8%), synopsis (50.0%), and registries (52.9%) in their IBD practice.
Conclusions:
This is the first IBD program survey in the United States showing that there is significant dissatisfaction and subsequent opportunity for EHR advancements to improve patient care. Although there are various tools available for EHR enhancement, many IBD programs are not utilizing these tools for patient care.