Krall M et al. 1995 "Acceptance and performance by clinicians using an ambulatory electronic medical record in an HMO."

Reference
Krall M. Acceptance and performance by clinicians using an ambulatory electronic medical record in an HMO. Annual Symposium on Computer Application in Medical Care; 1995; Philadelphia, PA: American Medical Informatics Association; 1995. p. 708.
Abstract
"The Northwest Region of Kaiser Permanente implemented a comprehensive clinical information system in two sites between February and December 1994. By year end 46 primary care clinicians and 95 supporting personnel used the system on a daily basis to provide patient care. Clinicians use the product to select code diagnoses, and directly order laboratory, Imaging, and other tests, internal referrals, and prescriptions. They enter progress notes into the system, and use it to generate patient focused visit summaries. Clinicians took approximately 2 minutes longer, on average, to complete patient visits post - implementation. Most of this time was spent performing "orders and diagnosis" work, which included new required elements in the post-implementation period. Clinicians worked approximately 30 days before reaching their baseline visit rate and "lost" approximately 48 hours of productivity during the learning, including classroom training. User acceptance improved from 2 to 4 months of use."
Objective
To describe the implementation of an electronic medical record system (EMR) in two clinics.
Type Clinic
Primary care
Size
Small, medium and large
Geography
Suburban
Other Information
The clinics in the study are the Rockwood clinic and the Sunset medical office, both in the Portland, Oregon area, and both part of the Kaiser Permanente Northwest Region.
Type of Health IT
Electronic medical records (EMR)
Type of Health IT Functions
"Clinicians use the product to select code diagnoses, and directly order laboratory, imaging, and other tests, internal referrals, and prescriptions. They enter progress notes into the system, and use it to generate patient focused visit summaries."
Workflow-Related Findings
"Fifty-two percent of clinicians agreed with the statement '[the EMR] is worth the time and effort required to use it' at 2 months ... Nine percent were neutral and 39% disagreed at that time (n=33). For clinicians reaching the 4-6 month post-'go-live' milestone, 85% now agreed, 9% were neutral and only 6% disagreed (n=34)."
Clinicians were spending an average of two minutes ten seconds longer with each patient when using the EMR versus the pre-implementation baseline. "Nearly all of this net increase (1:56) was attributable to the 'orders' task, with 'charting' making the second largest contribution."
Study Design
Pre-postintervention (no control group)
Study Participants
The study participants included nine family physicians, 12 internists, nine pediatricians, and 16 physician assistants or nurse practitioners.