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Clinician Satisfaction Before and
After Transition from a Basic to a
Comprehensive Electronic Health
Record
Allison B. McC...
Disclosure Statement
Southern Regional Meeting
February 26-28, 2015
Speaker: Allison B. McCoy, PhD
Dr. McCoy has documente...
Introduction
• Electronic health records (EHRs)
– Patient safety
– Provider efficiency
• Meaningful use incentive program
...
Introduction
• EHR adoption vs. possession
– Adoption – a specified set of EHR functions are
implemented in at least one c...
Objective
• Assess clinician satisfaction before, during,
and after transition from a basic, locally-
developed EHR to a c...
Study Setting
• Not-for-profit academic medical center
consisting of 8 hospitals and over 38 clinics in
urban and rural se...
Survey Methods
• Established survey methods1 based on
published tool2
– Online via e-mail
– Hard copy via standard mail
• ...
Survey Components
EHR System Use
• The EHR decreases time in scheduling of consults.
• …decreases the time in getting resu...
Survey Components
EHR System Use
• The EHR allows me to spend more time on other aspects of patient care.
• …increases coo...
Survey Components
Assessment of the EHR
• The EHR positively affects the quality of clinical decisions.
• …facilitates com...
Survey Components
Patient Care
• In providing patient care, have you avoided a drug allergy because
of the EHR?
• …avoided...
Survey Components
Satisfaction
• Overall, how satisfied are you with the EHR system?
• How satisfied are you with the ease...
Timeline
Baseline
Survey
EHR
Transition
First
Followup
Survey
Second
Followup
Survey
6 months 6 months
Analysis
• Unadjusted – McNemar’s chi-squared test
• Adjusted – random effect logistic regression
– Age
– Gender
– Setting...
Study Eligibility and Response
Contact information for active providers obtained
Ineligible
CRNAs, Residents, Fellows, PRN...
Respondents
Gender Male
Female
29 (62%)
18 (38%)
Age 26-35 years old
36-45 years old
46-55 years old
56-65 years old
> 65 ...
Respondents
Worked at
Study
Setting
< 1 year
1 to < 5 years
5 to < 10 years
10 to < 20 years
20 years or more
3 (6%)
13 (2...
Overall Provider Satisfaction
85.0%
66.0%
79.0%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Baseline 6 Months 1 Year
Note:...
Patient Safety
19%
83%
36%
72%
60%
9%
68%
13%
51%
57%
11%
66%
13%
40%
47%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Orde...
Health Information Exchange
38%
91%
85%
68%
64%
32%
96%
79%
64%
53%
26%
74%
87%
57%
38%
0% 10% 20% 30% 40% 50% 60% 70% 80%...
Productivity and Patient Care
40%
15%
68%
49%
28%
34%
17%
68%
43%
26%
62%
21%
83%
81%
45%
0% 10% 20% 30% 40% 50% 60% 70% 8...
Strengths and Limitations
• Longitudinal data over
three time periods
• Majority adopters in
real world setting vs.
innova...
Conclusions
• Overall and after adjustment for age, gender,
time in practice, and specialty, non-significant
trends of ini...
Conclusions
• Assessment of these trends in a larger sample is
underway.
• Longer follow up is necessary to determine if
E...
Implications
• Overcome barriers to EHR adoption
• Improve EHR training and rollout
• Improve patient safety and quality
Questions?
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Clinician Satisfaction Before and After Transition from a Basic to a Comprehensive Electronic Health Record

Healthcare organizations are transitioning from basic to comprehensive electronic health records (EHRs) to meet Meaningful Use requirements and improve patient safety. Yet, full adoption of EHRs is lagging and may be linked to clinician dissatisfaction. In depth assessment of satisfaction before, during, and after EHR transition is rarely done. Using an adapted published tool to assess adoption and satisfaction with EHRs, we surveyed clinicians at a large, non-profit academic medical center before (baseline) and 6-12 months (short-term follow-up) and 12-24 months (long-term follow-up) after transition from a basic, locally-developed to a comprehensive, commercial EHR. Satisfaction with the EHR (overall and by component) was captured at each interval. Overall satisfaction was highest at baseline (85%), lowest at short-term follow-up (66%), and increasing at long-term follow-up (79%). This trend was similar for satisfaction with EHR components designed to improve patient safety including clinical decision support, patient communication, health information exchange, and system reliability. Conversely, at baseline, short-term and long-term follow-up, perceptions of productivity, ability to provide better care with the EHR, and satisfaction with available resources, were lower at both short- and long-term follow-up compared to baseline. Persistent dissatisfaction with productivity and resources was identified. Addressing determinants of dissatisfaction may increase full adoption of EHRs. Further investigation in larger populations is warranted.

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Clinician Satisfaction Before and After Transition from a Basic to a Comprehensive Electronic Health Record

  1. 1. Clinician Satisfaction Before and After Transition from a Basic to a Comprehensive Electronic Health Record Allison B. McCoy, PhD Richard V. Milani, MD Elizabeth Holt, PhD Marie Krousel-Wood, MD, MSPH
  2. 2. Disclosure Statement Southern Regional Meeting February 26-28, 2015 Speaker: Allison B. McCoy, PhD Dr. McCoy has documented that she has nothing to disclose.
  3. 3. Introduction • Electronic health records (EHRs) – Patient safety – Provider efficiency • Meaningful use incentive program • Barriers to EHR adoption – Costs, return on investment – Loss of productivity, clinician dissatisfaction 1http://healthit.gov
  4. 4. Introduction • EHR adoption vs. possession – Adoption – a specified set of EHR functions are implemented in at least one clinical unit – Possession – the hospital has a legal agreement with the EHR vendor, but is not equivalent to adoption – 59% vs. 93% (hospitals)1 – 48% vs. 78% (office-based physicians)2 1Charles D, Gabriel M, Furukawa MF. ONC Data Brief, no. 16. 2014. 2Hsiao C-J, Hing E. NCHS data brief, no 143. 2014.
  5. 5. Objective • Assess clinician satisfaction before, during, and after transition from a basic, locally- developed EHR to a comprehensive, vendor EHR
  6. 6. Study Setting • Not-for-profit academic medical center consisting of 8 hospitals and over 38 clinics in urban and rural settings – Preliminary evaluation included one site • EHR use for more than a decade
  7. 7. Survey Methods • Established survey methods1 based on published tool2 – Online via e-mail – Hard copy via standard mail • Incentives provided – iPad raffle – Flash drive or pen with hard copy 1 Dillman, DA, et al. Mail and Internet Surveys: The Tailored Design Method. 2000. 2 DesRoches CM, et al. N Engl J Med 2008.
  8. 8. Survey Components EHR System Use • The EHR decreases time in scheduling of consults. • …decreases the time in getting results of consults. • …allows me to access, store and retrieve patient information without difficulties. • …provides easy access to relevant clinical information when patients are transitioning between hospital to clinic or clinic to hospital. • …provides timely and accurate information to me. • …is a valuable aid to me in tracking and/or monitoring patients.
  9. 9. Survey Components EHR System Use • The EHR allows me to spend more time on other aspects of patient care. • …increases coordination between departments. • …facilitates the process of scheduling patients. • …improves the safety of patients. • …improves my productivity on the job. • …allows me to provide better care for my patients. • I have sufficient access to computers with the EHR. • There are adequate resources (staff, training, help lines) available to turn to for help in solving problems with the EHR.
  10. 10. Survey Components Assessment of the EHR • The EHR positively affects the quality of clinical decisions. • …facilitates communication with other providers. • …facilitates communication with my patients. • …assists with prescription refills. • …provides me with timely access to medical records. • …helps providers to avoid medication errors. • …facilitates the delivery of preventive care that meets guidelines.
  11. 11. Survey Components Patient Care • In providing patient care, have you avoided a drug allergy because of the EHR? • …avoided a potentially dangerous medication interaction because of the EHR? • …been alerted to a critical lab value because of the EHR? • …provided preventive care (e.g. vaccine, colonoscopy, mammogram) because you were prompted by the EHR? • …ordered an indicated lab test (such as A1c or LDL) as a result of an electronic prompt from the EHR?
  12. 12. Survey Components Satisfaction • Overall, how satisfied are you with the EHR system? • How satisfied are you with the ease of use when providing direct care to a patient. • …the reliability of the system (i.e. frequency of system failures, system speed). • …the sharing of medical information with system hospitals and health-care providers. • …obtaining medical information from outside hospitals and providers
  13. 13. Timeline Baseline Survey EHR Transition First Followup Survey Second Followup Survey 6 months 6 months
  14. 14. Analysis • Unadjusted – McNemar’s chi-squared test • Adjusted – random effect logistic regression – Age – Gender – Setting (outpatient vs. inpatient vs. both) – Practice (primary care vs. specialty care) – Time worked at study setting
  15. 15. Study Eligibility and Response Contact information for active providers obtained Ineligible CRNAs, Residents, Fellows, PRN, Worked < 6 months, Resign/Retire over study period, etc. Eligible Active MDs, DOs, NP, PA, Optometry, Mental Health Professionals Baseline Respondents (N=83) First Follow-up Respondents (N=51) Second Follow-up Respondents (N=47) * Recapture Rate: 47/83 (57%)
  16. 16. Respondents Gender Male Female 29 (62%) 18 (38%) Age 26-35 years old 36-45 years old 46-55 years old 56-65 years old > 65 years old 4 (9%) 16 (34%) 13 (28%) 12 (26%) 2 (4%) Training Staff Physician - MD Staff Physician - DO Mid Level Provider Optometrist Mental Health Professional 35 (76%) 1 (2%) 7 (15%) 2 (4%) 1 (2%)
  17. 17. Respondents Worked at Study Setting < 1 year 1 to < 5 years 5 to < 10 years 10 to < 20 years 20 years or more 3 (6%) 13 (28%) 18 (38%) 9 (19%) 4 (9%) Setting Outpatient only Inpatient only Outpatient and inpatient 24 (51%) 5 (11%) 18 (38%) Practice Primary Care Medical Specialty Surgical Specialty Hospital Medicine Anesthesia Laboratory/Radiology Services 19 (42%) 6 (13%) 12 (27%) 4 (9%) 2 (4%) 2 (4%)
  18. 18. Overall Provider Satisfaction 85.0% 66.0% 79.0% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Baseline 6 Months 1 Year Note: Satisfaction = very satisfied/somewhat satisfied Unadjusted p=0.02, Adjusted p=0.11 Unadjusted p=0.03 Adjusted p=0.25 Unadjusted p=0.41, Adjusted p=0.53
  19. 19. Patient Safety 19% 83% 36% 72% 60% 9% 68% 13% 51% 57% 11% 66% 13% 40% 47% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Ordered an indicated lab test (such as A1c or LDL) as a result of an electronic prompt from the EHR. Been alerted to a critical lab value because of the EHR. Provided preventive care because you were prompted by the EHR? I feel the EHR improves the safety of patients. Using the EHR facilitates the delivery of preventive care that meets guidelines. Baseline 6 Months 1 Year Note: Satisfaction = very satisfied/somewhat satisfied, strongly agree/agree, in the last 6 months/ever *Unadjusted p < 0.05, †Adjusted p < 0.05 * * * * *
  20. 20. Health Information Exchange 38% 91% 85% 68% 64% 32% 96% 79% 64% 53% 26% 74% 87% 57% 38% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Obtaining medical information from outside hospitals and providers. Sharing of medical information with system hospitals and health-care providers. The EHR facilitates communication with other providers. The EHR facilitates communication with my patients. When patients are transitioning between hospital to clinic or clinic to hospital, the EHR provides easy access to relevant clinical information. Baseline 6 Months 1 Year Note: Satisfaction = very satisfied/somewhat satisfied, strongly agree/agree, in the last 6 months/ever *Unadjusted p < 0.05, †Adjusted p < 0.05 * * *
  21. 21. Productivity and Patient Care 40% 15% 68% 49% 28% 34% 17% 68% 43% 26% 62% 21% 83% 81% 45% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% There are adequate resources available to turn to for help in solving problems with the EHR. The EHR allows me to spend more time on other aspects of patient care. Ease of use when providing direct care to a patient. Using the EHR allows me to provide better care for my patients. Using the EHR improves my productivity on the job. Baseline 6 Months 1 Year Note: Satisfaction = very satisfied/somewhat satisfied, strongly agree/agree, in the last 6 months/ever *Unadjusted p < 0.05, †Adjusted p < 0.05 * * * * * * * †
  22. 22. Strengths and Limitations • Longitudinal data over three time periods • Majority adopters in real world setting vs. innovators and early adopters • Single study site • Modest response rate
  23. 23. Conclusions • Overall and after adjustment for age, gender, time in practice, and specialty, non-significant trends of initial lower satisfaction and subsequent improvement in satisfaction over time were identified. • Increasing trends were identified in several items related to patient safety and health information exchange.
  24. 24. Conclusions • Assessment of these trends in a larger sample is underway. • Longer follow up is necessary to determine if EHRs demonstrate improvements over time in patient care and safety in real-world settings. • Further research includes opportunities to identify components predictive of safety, quality, and EHR use.
  25. 25. Implications • Overcome barriers to EHR adoption • Improve EHR training and rollout • Improve patient safety and quality
  26. 26. Questions?
  • DRshubhampainoli

    Aug. 15, 2016

Healthcare organizations are transitioning from basic to comprehensive electronic health records (EHRs) to meet Meaningful Use requirements and improve patient safety. Yet, full adoption of EHRs is lagging and may be linked to clinician dissatisfaction. In depth assessment of satisfaction before, during, and after EHR transition is rarely done. Using an adapted published tool to assess adoption and satisfaction with EHRs, we surveyed clinicians at a large, non-profit academic medical center before (baseline) and 6-12 months (short-term follow-up) and 12-24 months (long-term follow-up) after transition from a basic, locally-developed to a comprehensive, commercial EHR. Satisfaction with the EHR (overall and by component) was captured at each interval. Overall satisfaction was highest at baseline (85%), lowest at short-term follow-up (66%), and increasing at long-term follow-up (79%). This trend was similar for satisfaction with EHR components designed to improve patient safety including clinical decision support, patient communication, health information exchange, and system reliability. Conversely, at baseline, short-term and long-term follow-up, perceptions of productivity, ability to provide better care with the EHR, and satisfaction with available resources, were lower at both short- and long-term follow-up compared to baseline. Persistent dissatisfaction with productivity and resources was identified. Addressing determinants of dissatisfaction may increase full adoption of EHRs. Further investigation in larger populations is warranted.

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