Gamm LD et al. 1998 "Pre- and post- control model research on end-users' satisfaction with an electronic medical record: preliminary results."

Reference
Gamm LD, Barsukiewicz CK, Dansky KH, et al. Pre- and post-control model research on end-users' satisfaction with an electronic medical record: preliminary results. J Am Med Inform Assoc 1998:225-229.
Abstract
"This study reports early results of a project that addresses the process of computerizing medical records in multiple ambulatory care sites of a health system. The study focuses on end-user attitudes before, during, and after implementation, through the use of questionnaires, interviews, and participant observation. Knowledge about end-user attitudes prior to computerization may contribute to planning for the training and implementation process. Tailoring these processes to meet the varying needs of user groups may result in a higher level of functional use of the system and less stress to the persons involved in its use. One implementation plan may not work for all sites when there are differences in size of the clinic, workflow patterns prior to implementation, and computer experience among personnel. Preliminary analysis of post-installation questionnaires and interviews six months after the installation point to a number of areas that might be usefully addressed in future installation efforts."
Objective
To address "the process of computerizing medical records in multiple ambulatory care sites of a health system" with a focus "on end-user attitudes before, during and after implementation."
Type Clinic
Primary care and specialty care
Size
Large
Geography
Rural
Other Information
The study was conducted at PennState Geisinger Health System, located in Pennsylvania.
Type of Health IT
Electronic medical records (EMR)
Type of Health IT Functions
Functions include documentation, scheduling consults and tests, billing, clinical reminders, and coding.
Workflow-Related Findings
"Preliminary analysis of post-installation survey data [shows that p]hysicians perceived increased time for medical recording, scheduling consults and tests, and supporting billing and other administrative tasks with EMR use."
"[P]reliminary analysis of post-installation survey data suggests that the end-users have not yet reached their expectations with respect to many measures of EMR utility [such as improving patient care and productivity, coordination and communication, relief from menial tasks and timely information flow]. Among the physicians, in particular, the post-installation utility ratings of the EMR are lower than ratings on expected utility. This occurs less among the clinical staff and even less among the support staff."
"Physicians expressed disappointment that reminders for health maintenance are not flexible to customize for particular patients and that some warnings and reminders are too broad-based to be helpful for specific patient needs."
"Most end-users...credit the EMR with providing them with a more complete and legible record."
"Problem areas with the project's software were mentioned by several physicians-needs for assistance in identifying the proper diagnostic and procedure codes on the EMR, needs for templates that might abbreviate the number of windows accessed during the patient visit, and need for improved standards in managing the clinical reminders."
"Physicians and clinical staff...report an increase in the amount of time required to enter data because of the numbers of screens that must be accessed and completed in order to document the patient encounter."
"Some physicians continued to be concerned about keeping the patient encounter personal while focused on data entry in the exam room."
"Physicians' difficulties regarding use of the EMR were frequently expressed in terms of maneuvering through the system's requirements."
Study Design
Pre-postintervention (no control group)
Study Participants
The study participants included 200 employees over nine clinic sites, including nearly equal numbers of physicians, nurses, and support staff. "Pre-installation survey data is available from seven ... sites. Reporting of post-installation comparison data is near completion from five implemented sites (three pre-tested installation sites and two sites untested prior to installation) along with repeat "pre-test data" from two of the original sites that have yet to install an EMR."