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.

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
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*
*
*
*†
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
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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