Carayon P et al. 2009 "Implementation of an electronic health records system in a small clinic: the viewpoint of clinic staff."
Reference
Carayon P, Smith P, Hundt AS, et al. Implementation of an electronic health records system in a small clinic: the viewpoint of clinic staff. Behaviour & Information Technology 2009; 28(1):5-20.
Abstract
"In this study, we examined the implementation of an electronic health records (EHR) system in a small family practice clinic. We used three data collection instruments to evaluate user experience, work pattern changes, and organisational changes related to the implementation and use of the EHR system: (1) an EHR user survey, (2) interviews with key personnel involved in the EHR implementation project, and (3) a work analysis of clinic staff. A longitudinal design with two data-collection rounds was employed: data were collected prior to EHR implementation and after EHR implementation. Both quantitative and qualitative data were collected and analysed. Employees of the small clinic perceived few changes in their work after the implementation of the EHR system, except for increased dependency on computers and a small increase in perceived workload. The work analysis showed a dramatic increase in the amount of time spent on computers by the various job categories. The EHR implementation did not change the amount of time spent by physicians with patients. On the other hand, the work of clinical and office staff changed significantly, and included decreases in time spent distributing charts, transcription and other clerical tasks. The interviews provided important contextual information regarding EHR implementation, and showed some positive elements (e.g., planning of training), but also some negative elements (e.g., unclear structure of the project) that would have deserved additional attention."
Objective
To "examine the implementation of an electronic health records (EHR) system in a small family practice clinic" and to "evaluate user experience, work pattern changes, and organisational changes related to the implementation and use of the EHR system."
Type Clinic
Primary care
Type Specific
Family practice
Size
Small and/or medium
Geography
Rural
Other Information
The study site is a University of Wisconsin family medicine residency clinic in a small community with a population of about 1,800, located 18 miles southwest of Madison, Wisconsin.
Type of Health IT
Electronic health records (EHR)
Workflow-Related Findings
After EHR implementation, the percentage of time clinical staff spent in examination and treatment of the patient increased from 3.5 to 11.7 percent. The time they spent performing lab tests with the physician declined from 10.4 to 1 percent.
After EHR implementation, the percentage of time that office staff spent alone doing data entry of medical information increased from 0 to 7.2 percent, while the time they spent alone doing transcription decreased from 11.7 to 6.5 percent.
"[Clinic employees] reported that the EHR system had some positive effect on their performance. They felt that the EHR system was moderately easy to learn and that the EHR system had moderate capabilities in terms of technical performance."
"All 4 interviewees agreed that clinic employees experienced changes in skills and work flow, and increased workload due to the implementation and use of EHR."
After EHR implementation, "[c]linical staff spent more time on the following functions: accompanying patients (from 17.5% to 22.9%), examining patient (from 4.3% to 12.7%), and maintaining medical information system (from 5.6% to 10.9%). Clinical staff spent less time on distributing chart/master file/mail (from 6.6% to 0.3%), and performing tests (from 18.6% to 11.2%). The functions of office staff also changed significantly: they spent about one-half less time for distributing chart/master file/mail (from 5.6% to 2.5%), general clerical assistance/office tasks (from 27.8% to 13.1%), and transcription (from 13.3% to 7.5%), but more time on maintaining the medical information system (0% to 19.8%)."
After EHR implementation, "[c]linical staff spent less time in contact with doctors and nurses, but more time with patients and patient representatives, and doing tasks by themselves. On the contrary, office staff spent more time with nurses, but less time doing tasks on their own."
After EHR implementation, the percentage of time the physician spent in examination and treatment of the patient increased from 40.4 to 45.9 percent. The time the physician spent on the phone providing instruction and information to the patient or patient representative declined from 7.3 to 1.5 percent. Overall, the amount of time physicians spent on patient care did not change.
Study Design
Pre-postintervention (no control group)
Study Participants
The study participants included 21 out of 25 clinic employees who completed the preimplementation survey. Twenty-five employees completed the postimplementation survey. Four key personnel were interviewed. Twenty-seven clinic employees participated in the preimplementation study, while 26 participated in the postimplementation study.