Electronic health records (EHRs) are taking over in hospitals and practices across the country, but some doctors have fiercely resisted the transition. What features would an EHR need to make doctors happy with a new system?

Ease of Use

A 2012 article from the Journal of AHIMA (American Health Information Management Association) includes a list of features and characteristics that an EHR would need to increase physician implementation. Most of these boil down to ease of transition:

  • Intuitive user interface

  • Flexibility and customizability

  • Systems that mimic familiar paper records

  • Ability to work on multiple devices (including tablets and laptops) and on-the-go

Essentially, doctors want an EHR to be no more difficult than paper. While the benefits of an EHR might be enormous, if those benefits come along with added difficulties in using the system, that may be the difference that doctors notice most. As EHRs become the standard, it will likely become less important for the system to mimic old paper records.

Credible, High-Quality Content

The same list also includes that doctors want the system to include trustworthy clinical guidance and other content. This was the only item on the list indicating that doctors envision that an EHR could offer more than paper records, rather than simply a better way of doing what paper records already do.

Minimal Interference with Doctor-Patient Relationship

A recently published study by Medscape examining doctor satisfaction with various EHRs found that 70% of physicians complained that their EHRs reduced face to face time with patients. Of physicians who were not using an EHR, 40% listed interference with doctor-patient relationship as one reason (the largest individual factor). In the 2012 edition of the same report, of physicians who felt that their EHR had a negative impact on doctor-patient relations (30%), 82% cited a reduction in eye contact with patient.

These observations by doctors are corroborated by data from a Northwestern study published earlier this year: when doctors were using EHRs, they spent one third of each patient visit looking at the screen, on average. Doctors using paper spent only 9% of the visit looking at the charts. The authors observed that this contributed to doctors missing nonverbal cues and the initiation of eye contact from patients.

Presumably, these doctors would not prefer to have access to less information. Rather, this goes along with the ease of use and transition requirement: the user interface must be clean and easy to navigate quickly, allowing the doctor to access the information efficiently and still spend a significant amount of time talking to, and looking at, the patient.


In the Medscape study, 37% of doctors not using EHRs listed cost as a reason. While costs vary significantly, over half of the respondents who knew the cost of their system reported that purchase and installation cost over $50,000 per doctor. Given the extraordinarily low up-front cost of paper records, the difference is enormous, and an EHR has to offer value to match its price. When the cost of not using an EHR is higher than the cost of the system, the remaining holdout doctors will likely be eager to switch.

Doctors may be trying to avoid disadvantages of EHRs more than they are looking forward to the benefits, but as the title of a recent Atlantic article asks: “If Doctors Don’t Like Electronic Medical Records, Should We Care?” Because, as a subtitle reminds us, despite any drawbacks, when using EHRs “fewer people die.” The other side of the raging debate, however, contends that doctors would and will use EHRs if and when the EHRs can fulfill their needs—at a reasonable price.

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