O'Connell RT et al. 2004 "Take note(s): differential EHR satisfaction with two implementations under one roof."
Reference
O'Connell RT, Cho C, Shah N, et al. Take note(s): differential EHR satisfaction with two implementations under one roof. J Am Med Inform Assoc 2004;11(1):43-49.
Abstract
"Objective: The aim of this study was to rigorously evaluate perceived differences in satisfaction with an electronic health record (EHR) between residents of two medical specialties who share the same health record, practice location, administration, and information technology support.
Design: A cross-sectional survey was used comparing user satisfaction between pediatrics residents and internal medicine residents in an academic practice.
Measurements: The survey was designed to measure baseline demographic characteristics, attitudes toward computers, general satisfaction with an EHR, and perceived practicality of use, variation from familiar practice, organizational support, and impact on delivery of care.
Results: Medicine subjects were similar to pediatrics subjects in baseline demographic characteristics. Satisfaction with the EHR implementation was very high for both sets of subjects, but internal medicine residents were significantly less likely to be satisfied with the EHR implementation (relative risk [RR] = 0.84, 95% confidence interval [CI] = 0.73-0.98) and considerably less likely to believe that their colleagues were satisfied with it (RR = 0.56, 95% CI = 0.41-0.77). The only surveyed characteristic independently predicting satisfaction was medical specialty (p = 0.04). Medicine subjects were less likely to believe template-based documentation improved their efficiency (RR = 0.64, 95% CI = 0.46-0.88). They were significantly more likely to believe the system had been designed to improve billing (RR = 1.50, 95% CI = 1.05-2.04) and not to improve patient care (RR = 0.61, 95% CI = 0.44-0.85).
Conclusion: The authors found a difference in satisfaction between internal medicine and pediatrics users of an EHR. Although many potential factors that influence satisfaction were similar between subjects in the two specialties, differences in previous experience may have influenced the results. Medicine residents had more previous experience with a different EHR implementation, which they may have perceived as superior to the one involved in this study. Pediatric residents had more previous experience with structured data entry prior to EHR implementation and more preventive care patient encounters for which structured data entry may be well suited. Since successful implementations generally require satisfied users, understanding what factors affect satisfaction can improve chances of a systems success."
Design: A cross-sectional survey was used comparing user satisfaction between pediatrics residents and internal medicine residents in an academic practice.
Measurements: The survey was designed to measure baseline demographic characteristics, attitudes toward computers, general satisfaction with an EHR, and perceived practicality of use, variation from familiar practice, organizational support, and impact on delivery of care.
Results: Medicine subjects were similar to pediatrics subjects in baseline demographic characteristics. Satisfaction with the EHR implementation was very high for both sets of subjects, but internal medicine residents were significantly less likely to be satisfied with the EHR implementation (relative risk [RR] = 0.84, 95% confidence interval [CI] = 0.73-0.98) and considerably less likely to believe that their colleagues were satisfied with it (RR = 0.56, 95% CI = 0.41-0.77). The only surveyed characteristic independently predicting satisfaction was medical specialty (p = 0.04). Medicine subjects were less likely to believe template-based documentation improved their efficiency (RR = 0.64, 95% CI = 0.46-0.88). They were significantly more likely to believe the system had been designed to improve billing (RR = 1.50, 95% CI = 1.05-2.04) and not to improve patient care (RR = 0.61, 95% CI = 0.44-0.85).
Conclusion: The authors found a difference in satisfaction between internal medicine and pediatrics users of an EHR. Although many potential factors that influence satisfaction were similar between subjects in the two specialties, differences in previous experience may have influenced the results. Medicine residents had more previous experience with a different EHR implementation, which they may have perceived as superior to the one involved in this study. Pediatric residents had more previous experience with structured data entry prior to EHR implementation and more preventive care patient encounters for which structured data entry may be well suited. Since successful implementations generally require satisfied users, understanding what factors affect satisfaction can improve chances of a systems success."
Objective
"To rigorously evaluate perceived differences in satisfaction with an electronic health record (EHR) between residents of two medical specialties who share the same health record, practice location, administration, and information technology support."
Tools Used
Type Clinic
Primary care
Type Specific
Internal medicine and pediatrics
Size
Large
Geography
Urban
Other Information
The study was conducted at the Yale-New Haven Hospital's Primary Care Center. The adult medicine clinic has 16,500 visits per year, compared to 20,000 per year for the pediatrics clinic.
Type of Health IT
Electronic health records (EHR)
Type of Health IT Functions
"As implemented..., the electronic record is used principally for documentation, and all clinical documentation currently is electronic. All notes are typed; there is no dictation. The system also serves to electronically generate orders such as radiology and laboratory orders as well as creation of prescriptions. Finally, the system serves to report results, such as laboratory and radiologic study data. The system under investigation did not generate any billing data or coding data. All care providers use the EHR, and resident physicians training in pediatrics or internal medicine use it in a similar way."
Workflow-Related Findings
"Medicine users were less likely to be satisfied with the EHR implementation...Despite the difference in satisfaction between the specialty groups, the majority (91%) of all subjects reported general satisfaction with the EHR implementation. Ninety-eight percent of pediatrics subjects and 83% of medicine subjects reported they were 'generally satisfied.' Almost all agreed that the benefits of health records outweighed the disadvantages. Both medicine and pediatrics users preferred to use electronic notes instead of paper-based recording to document visits."
"While medicine users were more likely to believe the design of the EHR's user interface was to improve billing, pediatrics users were more likely to believe the design was intended to improve patient care or be used as a teaching tool for residents."
"Pediatrics users found [the EHR] more practical to use. Although medicine and pediatrics subjects felt similarly about ease of prescription writing and order entry, medicine subjects were less likely to finish notes before leaving the clinic. Of five survey items pertaining to structured documentation, all indicated a more favorable perception by pediatrics subjects. Furthermore, medicine residents were much more likely to prefer documentation of scheduled health maintenance visits using free text (no templates) as compared with pediatrics residents."
"There was a high level of agreement in both specialties that use of the system did not interfere with the doctor-patient relationship. However, pediatrics residents were more likely to agree that they were accustomed to writing notes in the way the new system required."
"Neither pediatrics nor medicine users perceived using the system as a disruption in their usual practice patterns."
"The difference found in user expectations may be partially explained by prior experience of users. Almost all medicine users-but relatively few pediatrics users-had extensive experience with another ambulatory electronic health record. The Veterans Affairs Hospital's Computerized Patient Record System (CPRS) is used by all medical residents for several months during their training, whereas pediatrics residents have no consistent exposure to alternate EHR systems in the course of their training. The experience medicine users have with another EHR likely colors their point of view and expectations of an electronic record."
Study Design
Only postintervention (no control group)
Study Participants
All internal medicine (41) and pediatrics (45) residents from the Primary Care Center were invited to participate in the study. Of these, all 45 pediatrics residents and 40 of 41 (98 percent) of internal medicine residents completed the survey.