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

  1. 1. 0% 20% 40% 60% 80% 100% There are adequate resources available to turn to for help in solving problems with the EHR. At my main practice site, I have sufficient access to computers with the EHR. Using the EHR allows me to provide better care for my patients. Using the EHR improves my productivity on the job. I feel the EHR improves the safety of patients. Using the EHR facilitates the process of scheduling patients. Using the EHR increases coordination between departments. The EHR allows me to spend more time on other aspects of patient care. The EHR is a valuable aid to me in tracking and/or monitoring patients. The EHR provides timely and accurate information to me. Using the EHR allows me to access, store and retrieve patient information without difficulties. When patients are transitioning between hospital and clinic, the EHR provides easy access to relevant clinical information. Using the EHR decreases the time in getting results of consults. Using the EHR decreases time in scheduling of consults. 0% 20% 40% 60% 80% 100% Using the EHR facilitates the delivery of preventive care that meets guidelines. The EHR helps providers to avoid medication errors. The EHR provides me with timely access to medical records. Using the EHR assists with prescription refills. The EHR facilitates communication with my patients. The EHR facilitates communication with other providers. The EHR positively affects the quality of clinical decisions. 0% 20% 40% 60% 80% 100% Ordered an indicated lab test (such as A1c or LDL) as a result of an electronic prompt from the EHR Provided preventive care (e.g. vaccine, colonoscopy, mammogram) because you were prompted by the EHR Been alerted to a critical lab value because of the EHR Avoided a potentially dangerous medication interaction because of the EHR Avoided a drug allergy because of the EHR 0% 20% 40% 60% 80% 100% Obtaining medical information from outside hospitals and providers Sharing of medical information with system hospitals and health-care providers Reliability of the system (i.e. frequency of system failures, system speed) Ease of use when providing direct care to a patient Overall, how satisfied are you with the EHR system? 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 * * * * *† * * * * * * * * * * * * * * * * * * * 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 Objective Assess clinician satisfaction before, during, and after transition from a basic, locally-developed EHR to a comprehensive, vendor EHR Introduction • Many healthcare settings are transitioning from basic, often locally developed, to fully functional, commercial electronic health records (EHRs) to meet Meaningful Use requirements and improve patient safety. • Assessment and improvement of clinician satisfaction with EHRs is becoming increasingly important to improve adoption of EHRs by clinicians. • Some barriers to EHR adoption include concerns about cost and return on investment, along with the potential for loss of productivity and resulting clinician dissatisfaction. • While decreased satisfaction as a result of such changes is expected, comprehensive assessment of satisfaction before, during, and after these changes is rarely performed. Study Setting • Ochsner Health System is a not-for-profit academic health system consisting of 8 hospitals and over 38 health centers in urban and rural settings. - Preliminary evaluation included one site • Recently, clinicians began using a comprehensive, commercial EHR (Epic 2010, Madison, WI) in both inpatient and ambulatory settings after having used a basic, locally-developed EHR (Ochsner Clinical Workstation, New Orleans, LA) for more than a decade. Survey Methods • We used established survey methods1 and adapted a survey to assess satisfaction using measures from a recently published national survey for physicians about EHR adoption, satisfaction, and perceptions2 - Online via e-mail - Hard copy via standard mail • Incentives provided - iPad raffle - Flash drive or pen with hard copy Survey Timeline Survey 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 Study Eligibility and Response Respondents Overall Provider Satisfaction EHR System Use Assessment of the EHR Patient Care Strengths • Longitudinal data over three time periods • Majority adopters in real world setting vs. innovators and early adopters Limitations • Single study site • Modest response rate 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. • 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. Satisfaction Implications • Overcome barriers to EHR adoption • Improve EHR training and rollout • Improve patient safety and quality References 1. Dillman, DA, et al. Mail and Internet Surveys: The Tailored Design Method. 2000. 2. DesRoches CM, et al. N Engl J Med 2008. Baseline   Survey   EHR   Transi2on   First   Followup   Survey   Second   Followup   Survey   6  months   6  months   Contact  informa,on  for  ac,ve  providers  obtained   Ineligible   CRNAs,  Residents,  Fellows,  PRN,  Worked  <  6   months,  Resign/Re,re  over  study  period,  etc.   Eligible   Ac,ve  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%)   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%)   Worked   at  Study   Se3ng   <  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%)   Se3ng   OutpaMent  only   InpaMent  only   OutpaMent  and  inpaMent   24  (51%)   5  (11%)   18  (38%)   Prac6ce   Primary  Care   Medical  Specialty   Surgical  Specialty   Hospital  Medicine   Anesthesia   Laboratory/Radiology  Services   19  (42%)   6  (13%)   12  (27%)   4  (9%)   2  (4%)   2  (4%)   85.0%   66.0%   79.0%   0%   10%   20%   30%   40%   50%   60%   70%   80%   90%   100%   Baseline   6  Months   1  Year   Note:  Sa>sfac>on  =  very  sa>sfied/somewhat  sa>sfied   Unadjusted  p=0.02,     Adjusted  p=0.11   Unadjusted  p=0.03   Adjusted  p=0.25   Unadjusted  p=0.41,  Adjusted  p=0.53  

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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