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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	
  

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

  • 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