Electronic Medical Records and Handheld Computing by Physician Assistants in Clinical Practice An Applied Dissertation Submitted to the Fischler School of Education and Human Services in Partial Fulfillment of the Requirements for the Degree of Doctor of Education Calvin R. Finley, Ed.D., PA-C Assistant Professor Physician Assistant Department College of Allied Health and Nursing Nova Southeastern University
Rogers (2003) related that scholars of diffusion have found that individuals gain awareness knowledge through behavior that must be initiated, adding that the need for an innovation must usually precede awareness knowledge of the innovation.
The results of this study may lead to the development of guidelines that, when put into effect, would increase the effective use of PDAs in association with EMRs to meet the needs of clinicians and patients during the medical encounter.
Figure 3. Number of respondents using PDAs in daily clinical practice. 1 = not using a PDAs in daily clinical practice; 2 = less than once a week; 3 = once a week; 4 = several days a week; and 5 = everyday.
42 Alert to drug-drug interactions 35 Alert to drug-patient interactions or drug allergies 5 Access embedded clinical practice guidelines 13 Generate recall lists and reminder notices 3 Generate and print patient educational material 4 Electronically store scanned photos 3 Electronically capture and store lab results 18 Access medically related Web sites 3 Access patient files from remote location Frequency Clinical Application Clinical Application Use of a PDA Only
6 Do not use for personal activities 8 Coordination with Outlook 27 Games 10 Electronic communications 52 Personal or private scheduling 7 Personal word processing 8 Personal finances 56 Education Frequency Personal Application Personal Application Use of a PDA Only
2 Enter patient visit notes via keyboard 2 Print prescriptions 4 Alert to drug-drug interactions 4 Alert to drug-patient interactions or drug allergies 2 Electronically transfer patient files to other locations 2 Access patient files from remote location Frequency Clinical Application Clinical Application Use of a PDA in Conjunction With an EMR
1 2 2 Improves patient satisfaction 1 3 0 Improves clinical data capture Facilitates clinical decision support Provides access at remote locations Improves patient safety Improves workflow efficiency Improves quality of patient care Shares patient record information Clinical Skills Benefits of Using a PDA in Conjunction With an EMR System 2 0 3 1 2 2 Agree 3 2 2 3 3 2 Strongly Agree 0 2 0 1 0 0 Disagree
Increases the number of patients that are seen Saves time Provides a more complete patient medical record Provides better access to radiology results Provides better access to laboratory results Improves efficiency of post-visit patient education Clinical Skills Benefits of Using a PDA in Conjunction With an EMR System 1 1 2 2 1 2 Agree 2 3 1 0 2 0 Strongly Agree 2 1 2 2 2 2 Disagree
Changed the way in which you practice medicine Improves your patient communication skills Improves your treatment planning skills Assists in readily obtaining answers to complex patient management problems Assists in logically organizing information Enhances your problem solving skills Clinical Skills Benefits of PDA and EMR Integration on Clinical Skills 1 1 0 2 3 2 Agree 3 1 3 2 2 3 Strongly Agree 1 3 2 1 0 0 Disagree
Universal implementation of EHRs will produce a profound societal return---improving care and reducing costs . . . Enhanced quality and patient safety through improved continuity of care and clinical decision making, reduced clerical and administrative costs, and more effective use of health services. (p. 13)
With a large percentage of PAs and other health care providers using PDAs and a greater emphasis on the implementation of EMRs by organizations that provide health care:
The integration of PDAs and EMRs should be given a higher priority for the overall success of the diffusion of these innovations into the health care delivery system
Future studies should concentrate on isolating the major factors that influence the adoption of PDA use in conjunction with EMRs, so that efforts to support the positive factors and remove barriers can be more focused
Unless there is a concerted effort on a national level to negate the barriers to PDA/EMR integration, we may have to give a new meaning to the term “digital divide”