Campbell JR et al. 1989 "Computerized medical records and clinic function."

Campbell JR, Givner N, Seelig CB, et al. Computerized medical records and clinic function. MD Comput 1989;6(5):282-287.
"Formal studies of computerized information systems for ambulatory patients are rare. As part of an evaluation of the effects of such a system on clinic function, we divided the residents in our teaching clinic into a study group with access to [an EMR] and a control group with access to conventional medical records alone. Nurses and clerical personnel in the clinic were allowed to use the computerized records only for patients of residents in the study group. We sampled the attitudes of nurses and clerical personnel toward use of the computer and performed detailed time studies of patient flow in the clinic. Responses to questionnaires reflected acceptance of computerization by the personnel sampled, who favored [electronic] records over conventional records, primarily because of the increased availability of information for telephone management and demand care. The residents never became facile users of [the EMR]--a problem that we attribute to the infrequency of their clinic sessions. As a result, and because the workloads of residents using [the EMR] were larger, waiting times were longer in clinics attended by these residents. Overall, the most intensive users of the computerized medical records were not the physicians. Improved productivity and better use of time among the nurses and clerical personnel were thought to outweigh the residents' perceptions."
To evalute the effect of computerized medical records systems use in ambulatory patient care.
Type Clinic
Primary care
Type Specific
Internal medicine
Other Information
The study was conducted at the Internal Medicine Department at the University of Nebraska College of Medicine.
Type of Health IT
Electronic medical records (EMR)
Type of Health IT Functions
Functions that were mentioned were computerized records including patient care notes, health maintenance reminders, lab data, and x-ray findings.
Workflow-Related Findings
"Using the conventional record, therefore, the nurses and clerical personnel waited for information for a total of 5590 hours before making decisions related to telephone calls, and could not act with complete information in 2880 separate telephone contacts. In contrast, computerized records were instantly available at clinic terminals 99.05 percent of the time ... Clinic personnel commented that the computer system was faster in that data review and recording could be accomplished in one step."
"Patients seen by residents in the study group, with access to the [electronic] record, spent more time [approximately 5 minutes on average] in the waiting room than patients seen by residents in the control group."
"Nurses and clerical workers consistently and strongly preferred all aspects of the [EHR] record that were operational during our project. The only feature for which they preferred the conventional record was the provision of hospitalization summaries -- a type of information that was not duplicated in the [electronic] record."
"The resident physicians were less enthusiastic [about the EMR]," a finding attributed to their infrequent use of the system. Concern about the increased waiting time of patients was expressed by "frustrated residents who found that learning a new computer system during a busy clinic could be a negative experience."
"Furthermore, the patients seen by the [EMR] group spent more time in the clinic as a whole [approximately 10 minutes on average] and more time at the checkout desk."
The reasons for longer patient waiting times may include the fact that residents in the study group performed time-consuming procedures, like flexible sigmoidoscopy, more often. "If the computer reminds residents to screen patients and the physician then performs sigmoidoscopy more frequently," patient visits will be longer on average. Also, "interviews with residents indicated that biweekly clinics and infrequent exposure the to computer were detrimental to their ability to use it."
Study Design
Only postintervention with intervention and control groups
Study Participants
The study participants included medical residents, nurses and clerical personnel.