Christensen T et al. 2008 "Instant availability of patient records, but diminished availability of patient information: a multi-method study of GP's use of electronic patient records."
Reference
Christensen T, Grimsmo A. Instant availability of patient records, but diminished availability of patient information: a multi-method study of GP's use of electronic patient records. BMC Med Inform Decis Mak 2008;8:12
Abstract
"Background: In spite of successful adoption of electronic patient records (EPR) by Norwegian [general practitioners] GPs, what constitutes the actual benefits and effects of the use of EPRs in the perspective of the GPs and patients has not been fully characterized. We wanted to study primary care physicians' use of electronic patient record (EPR) systems in terms of use of different EPR functions and the time spent on using the records, as well as the potential effects of EPR systems on the clinician-patient relationship.
Methods: A combined qualitative and quantitative study that uses data collected from focus groups, observations of primary care encounters and a questionnaire survey of a random sample of general practitioners to describe their use of EPR in primary care.
Results: The overall availability of individual patient records had improved, but the availability of the information within each EPR was not satisfactory. GPs' use of EPRs were efficient and comprehensive, but have resulted in transfer of administrative work from secretaries to physicians. We found no indications of disturbance of the clinician-patient relationship by use of computers in this study.
Conclusion: Although GPs are generally satisfied with their EPRs systems, there are still unmet needs and functionality to be covered. It is urgent to find methods that can make a better representation of information in large patient records as well as prevent EPRs from contributing to increased administrative workload of physicians."
Methods: A combined qualitative and quantitative study that uses data collected from focus groups, observations of primary care encounters and a questionnaire survey of a random sample of general practitioners to describe their use of EPR in primary care.
Results: The overall availability of individual patient records had improved, but the availability of the information within each EPR was not satisfactory. GPs' use of EPRs were efficient and comprehensive, but have resulted in transfer of administrative work from secretaries to physicians. We found no indications of disturbance of the clinician-patient relationship by use of computers in this study.
Conclusion: Although GPs are generally satisfied with their EPRs systems, there are still unmet needs and functionality to be covered. It is urgent to find methods that can make a better representation of information in large patient records as well as prevent EPRs from contributing to increased administrative workload of physicians."
Objective
To study "primary care physicians' use of electronic patient record (EPR) systems in terms of use of different EPR functions and the time spent on using the records, as well as the potential effects of EPR systems on the clinician-patient relationship."
Tools Used
Type Clinic
Primary care
Type Specific
Family practice
Size
Small and/or medium
Geography
Urban and rural
Other Information
"Most Norwegian GPs are self employed and organized in medical practices of an average of 3-4 physicians in a system with enlisted patients." Two groups in the city of Trondheim and one in the countryside were studied.
Type of Health IT
Electronic medical records (EMR)
Type of Health IT Functions
"Different sections or modules for basic data, medical data, scheduling, financial functions, communications, statistics and other functions build up the EPR systems... The EPR supports most clinical tasks such as free text progress notes, computerized physician order entry, drug prescription, electronic communication... The EPR systems in Norway do not include decision support or instructions on medical procedures."
Context or other IT in place
The context varied across practices.
Workflow-Related Findings
In documentation, "you don't need to write the headings over and over again, and you can also reuse text templates."
"A shift in administrative workload from health secretaries to GPs was also pointed out. Examples mentioned were scheduling and filling in forms as well as writing referral letters and updating demographic data." As noted, "Earlier I dictated referrals. Now I type them myself."
"GPs rarely spent time searching for historical information in the EPR other than the latest progress notes, medications and results on laboratory tests. Instead, the GPs seemed to rely on their own memory or obtained information through asking the patients about previous episodes."
"Several participants expressed concerns about the potential negative influence of computers on the clinician-patient relationship, particularly when the computer screen drew the GP's attention away from the patient.... Most of them stated they were aware of the possibility of disturbing their relationship with the patient, and that they tried to avoid such disturbance. We observed that most of the GPs read in the EPR before the encounter began, minimized the use of the EPR during the encounters, and often did the documentation work when the patient had left."
Some GPs stated that it was both relevant and useful to conduct documentation work while the patient was still in the room: 'When I am not sure if I have understood things right; I write the record note while the patient is present, show him the note and ask if it is correctly formulated.'"
"Saving time looking for patient records was pointed out by many in the focus groups as a great advantage of EPRs compared to paper records."
"Some of the informants indicated that the overview sometimes could be better in previous paper records: 'When using paper records we could spread out the papers on the desk to get an overview.'"
"GPs read the previous progress note or other parts of the EPR before calling the patient into the office in 36 of 44 observed encounters."
"37% [of GPs] sometimes reported to give up searching for information because it was too time-consuming. 35% found it easier to ask the patient again rather than to search in the patient record. Almost a third (28%) only occasionally tried to search for information because they found it was too time-consuming."
"A majority of the GPs emphasized the great time and work savings offered by EPR systems compared to paper records. This was exemplified by renewal of regular prescriptions and account keeping, as well as use of text templates and automatic reuse of administrative and clinical information when writing referral letters, requisitions and forms."
"More than half of the respondents (57%) found it difficult to display a summary of the actual progress notes."
"Patient records with many progress notes and documents were often dominated by redundancy of information and the GPs had problems with achieving sufficient overview. Many of the respondents felt it was troublesome to track earlier episodes and notes in the EPR."
"In the observation study we interviewed 24 of the patient after the encounters. None of them expressed discomfort with the GP's use of the computer during the encounter nor felt that the screen was an obstacle between them and the clinician."
Study Design
Only postintervention (no control group)
Study Participants
Twenty-three GPs were involved in focus groups. A total of 80 GP patient encounters involving four female and seven male GPs in five medical practices were observed. A questionnaire was completed by 229 GPs.