1
|
Lefchak B, Bostwick S, Rossetti S, Shen K, Ancker J, Cato K, Abramson EL, Thomas C, Gerber L, Moy A, Sharma M, Elias J. Assessing Usability and Ambulatory Clinical Staff Satisfaction with Two Electronic Health Records. Appl Clin Inform 2023; 14:494-502. [PMID: 37059455 PMCID: PMC10306987 DOI: 10.1055/a-2074-1665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/19/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND A growing body of literature has linked usability limitations within electronic health records (EHRs) to adverse outcomes which may in turn affect EHR system transitions. NewYork-Presbyterian Hospital, Columbia University College of Physicians and Surgeons (CU), and Weill Cornell Medical College (WC) are a tripartite organization with large academic medical centers that initiated a phased transition of their EHRs to one system, EpicCare. OBJECTIVES This article characterizes usability perceptions stratified by provider roles by surveying WC ambulatory clinical staff already utilizing EpicCare and CU ambulatory clinical staff utilizing iterations of Allscripts before the implementation of EpicCare campus-wide. METHODS A customized 19-question electronic survey utilizing usability constructs based on the Health Information Technology Usability Evaluation Scale was anonymously administered prior to EHR transition. Responses were recorded with self-reported demographics. RESULTS A total of 1,666 CU and 1,065 WC staff with ambulatory self-identified work setting were chosen. Select demographic statistics between campus staff were generally similar with small differences in patterns of clinical and EHR experience. Results demonstrated significant differences in EHR usability perceptions among ambulatory staff based on role and EHR system. WC staff utilizing EpicCare accounted for more favorable usability metrics than CU across all constructs. Ordering providers (OPs) denoted less usability than non-OPs. The Perceived Usefulness and User Control constructs accounted for the largest differences in usability perceptions. The Cognitive Support and Situational Awareness construct was similarly low for both campuses. Prior EHR experience demonstrated limited associations. CONCLUSION Usability perceptions can be affected by role and EHR system. OPs consistently denoted less usability overall and were more affected by EHR system than non-OPs. While there was greater perceived usability for EpicCare to perform tasks related to care coordination, documentation, and error prevention, there were persistent shortcomings regarding tab navigation and cognitive burden reduction, which have implications on provider efficiency and wellness.
Collapse
Affiliation(s)
- Brian Lefchak
- NewYork-Presbyterian Hospital, New York, New York, United States
- Department of Pediatrics, Weill Cornell Medical Center, New York, New York, United States
| | - Susan Bostwick
- Department of Pediatrics, Weill Cornell Medical Center, New York, New York, United States
| | - Sarah Rossetti
- Department of Biomedical Informatics, Columbia University, New York, New York, United States
- Columbia University School of Nursing, New York, New York, United States
| | - Kenneth Shen
- NewYork-Presbyterian Hospital, New York, New York, United States
- Department of Pediatrics, Weill Cornell Medical Center, New York, New York, United States
| | - Jessica Ancker
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, United States
| | - Kenrick Cato
- Columbia University School of Nursing, New York, New York, United States
| | - Erika L. Abramson
- Department of Pediatrics, Weill Cornell Medical Center, New York, New York, United States
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, United States
| | - Charlene Thomas
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, United States
| | - Linda Gerber
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, United States
| | - Amanda Moy
- Department of Biomedical Informatics, Columbia University, New York, New York, United States
| | - Mohit Sharma
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, United States
| | - Jonathan Elias
- NewYork-Presbyterian Hospital, New York, New York, United States
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, United States
| |
Collapse
|
2
|
Millares Martin P. Consultation analysis: use of free text versus coded text. HEALTH AND TECHNOLOGY 2021; 11:349-357. [PMID: 33520588 PMCID: PMC7829039 DOI: 10.1007/s12553-020-00517-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 12/21/2020] [Indexed: 11/28/2022]
Abstract
General practice in the United Kingdom has been using electronic health records for over two decades, but coding clinical information remains poor. Lack of interest and training are considerable barriers preventing code use levels improvement. Tailored training could be the way forward, to break barriers in the uptake of coding; to do so it is paramount to understand coding use of the particular clinicians, to recognise their needs. It should be possible to easily assess text quantity and quality in medical consultations. A tool to measure these parameters, which could be used to tailor training needs and assess change, is demonstrated. The tool is presented and a preliminary study using a randomised sample of five recent consultations from thirteen different clinicians is used as an example. The tool, based on using a word processor and a spread-sheet, allowed quantitative analysis among clinicians while word clouds permitted a qualitative comparison between coded and free text. The average amount of free text per consultation was 68.2 words, (ranging from 25.4 and 130.2 among clinicians); an average of 6% of the text was coded (ranging from 0 to 13%). Patterns among clinicians could be identified. Using Word cloud, a different text use was demonstrated depending on its purpose. Some free text could be turned into code but nomenclature probably prevented some of the codings, like the expression of time. This proof of concept demonstrated that it is possible to calculate what percentage of consultations are coded and what codes are used. This allowed understanding clinicians’ preferences; training needs and gaps in nomenclature.
Collapse
|
3
|
Hemmat M, Ayatollahi H, Maleki M, Saghafi F. Health information technology foresight for Iran: A Delphi study of experts' views to inform future policymaking. HEALTH INF MANAG J 2021; 50:76-87. [PMID: 31416345 DOI: 10.1177/1833358319868445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Policymakers require a systematic approach when planning for information technology needs in healthcare. OBJECTIVE The aim of this study was to obtain experts' predictions of future health information technology (HIT) needs until 2025 for Iran in relation to the relative importance of key technologies, expected timeframe of realisation, areas that may be impacted upon and obstacles to achieving these goals. METHOD This article presents results from the third phase (a Delphi study) of a larger mixed-method study. Policymakers from the Iranian Ministry of Health and faculty members from different medical universities across the country who were expert in the field of HIT were invited to participate (n = 61). RESULTS Participants (39) completed the first-round questionnaire and 24 completed the second. The development of personal health records (n = 32, 82.0%), the development of clinical decision-making systems (n = 30, 76.9%) and the use of business intelligence for collecting and analysing clinical and financial data (n = 32, 82.0%) were predicted to occur after 2025. The healthcare areas predicted to experience the greatest impact from most HITs were facilitating patient-provider communication and improving healthcare quality. Key barriers to achieving HITs were related to weaknesses in planning and limited financial resources for most technologies. CONCLUSION By identifying the areas of impact and the barriers to achieving the HIT goals, more accurate planning is possible and resources can be allocated according to priorities.
Collapse
Affiliation(s)
| | - Haleh Ayatollahi
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | | |
Collapse
|
4
|
Martin PM, Sbaffi L. Electronic Health Record and Problem Lists in Leeds, United Kingdom: Variability of general practitioners' views. Health Informatics J 2019; 26:1898-1911. [PMID: 31875417 DOI: 10.1177/1460458219895184] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Data sharing of Electronic Health Records from general practices to secondary care in Leeds occurs through the so-called Leeds Care Records, which collects a specific set of codes from primary care, known as 'Active Problems', and presents it to the user. Variability on its content is a known issue. To explore general practitioners' views on their use of 'Active Problems' and on sharing data, so lessons could be learnt on how to homogenise and improve shared data. Assessing Leeds general practitioners' views through two parallel processes (60 online surveys and 17 interviews). General practitioners feel they do not have the time nor the training required for keeping a shared approach to concise and current Problem Lists in electronic patient records. Action is needed to reduce current variability, and to improve the quality of shared information. Some types of codes currently present in Problem Lists have very little support among general practitioners who consider the focus should be on long-term conditions and probably adding current acute diagnoses and life expectancy items and not omitting sensitive information. There is a perceived need of training and time to update Problem Lists if their quality is to improve.
Collapse
|
5
|
Strekalova YA. Electronic health record use among cancer patients: Insights from the Health Information National Trends Survey. Health Informatics J 2017; 25:83-90. [DOI: 10.1177/1460458217704246] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Over 90% of US hospitals provide patients with access to e-copy of their health records, but the utilization of electronic health records by the US consumers remains low. Guided by the comprehensive information-seeking model, this study used data from the National Cancer Institute’s Health Information National Trends Survey 4 (Cycle 4) and examined the factors that explain the level of electronic health record use by cancer patients. Consistent with the model, individual information-seeking factors and perceptions of security and utility were associated with the frequency of electronic health record access. Specifically, higher income, prior online information seeking, interest in accessing health information online, and normative beliefs were predictive of electronic health record access. Conversely, poorer general health status and lack of health care provider encouragement to use electronic health records were associated with lower utilization rates. The current findings provide theory-based evidence that contributes to the understanding of the explanatory factors of electronic health record use and suggest future directions for research and practice.
Collapse
|
6
|
Sines CC, Griffin GR. Potential Effects of the Electronic Health Record on the Small Physician Practice: A Delphi Study. PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2017; 14:1f. [PMID: 28566989 PMCID: PMC5430134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The Health Information Technology for Economic and Clinical Health (HITECH) Act established the requirement of all medical practices to have certified electronic health records (EHRs). Some primary concerns that have been delaying implementation are issues of cost, revenue impact, and the effect on the patient encounter. Small physician practices (one to four physicians) account for 46 percent of all physicians. The purpose of this qualitative study using a modified Delphi research design was to examine the potential effect of the adoption of the EHR on revenue, unintended costs or savings, and changes in the patient encounter. Fifteen expert panelists completed the three-round survey process. The expert panelists reached a consensus that EHRs would reduce the number of patients seen per day, thereby reducing their revenue. Although the panelists limited their discussion on the effect of patient outcomes, their most dominant concern was the loss of face-to-face time with the patient. They felt that the use of an EHR would reduce the focus on the patient and potentially cause physicians to miss medical conditions. The results of this study indicate an avenue for EHR vendors to develop educational avenues to teach physicians how to optimize the EHR as well as to share success stories that demonstrate improved financial impact.
Collapse
|
7
|
Ehrlich JR, Michelotti M, Blachley TS, Zheng K, Couper MP, Greenberg GM, Kileny S, Branford GL, Hanauer DA, Weizer JS. A Two-Year Longitudinal Assessment of Ophthalmologists' Perceptions after Implementing an Electronic Health Record System. Appl Clin Inform 2016; 7:930-945. [PMID: 27730248 DOI: 10.4338/aci-2016-05-ra-0075] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 08/17/2016] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To understand the attitudes and perceptions of ophthalmologists toward an electronic health record (EHR) system, before and after its clinical implementation. METHODS Ophthalmologists at a single large academic ophthalmology department were surveyed longitudinally before and after implementation of a new EHR system. The survey measured ophthalmologists' attitudes toward implementation of a new EHR. Questions focused on satisfaction, efficiency, and documentation. All attending physicians (between 56 and 61 at various time points) in the University of Michigan Department of Ophthalmology and Visual Sciences were surveyed. We plotted positive responses to survey questions and assessed whether perceptions followed a J-curve with an initial decrease followed by an increase surpassing pre-implementation levels. RESULTS Survey responses were received from 32 (52%) ophthalmologists pre-implementation, and 28 (46%) at 3 months, 35 (57%) at 7 months, 40 (71%) at 13 months and 39 (67%) at 24 months post-implementation. After EHR implementation respondents were more likely to express concerns about their ability to create high-quality documentation (p<0.01) and the impact of an electronic health record on meaningful patient interaction (p<0.01). Physicians did not report a significant change in the amount of time spent documenting outside of regular clinical work hours (p=0.54) or on their clinic efficiency and workflow (p=0.97). There was no significant change in overall job satisfaction during the study period (p=0.69). We did not observe a J-curve for any of the survey responses analyzed. CONCLUSIONS As ophthalmology practices continue to transition to EHRs, adapting them to their specific culture and needs is important to maintain efficiency and user satisfaction. This study identifies areas of concern to ophthalmologists that may be addressed through education of physicians and customization of software as other practices move forward with EHR implementation.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jennifer S Weizer
- Jennifer S. Weizer, MD, Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, 1000 Wall Street, Ann Arbor, MI 48105, Fax: (734) 232-0865, Telephone: (734) 936-9503,
| |
Collapse
|
8
|
Asan O, Holden RJ, Flynn KE, Yang Y, Azam L, Scanlon MC. Provider Use of a Novel EHR display in the Pediatric Intensive Care Unit. Large Customizable Interactive Monitor (LCIM). Appl Clin Inform 2016; 7:682-92. [PMID: 27453191 PMCID: PMC5052542 DOI: 10.4338/aci-2016-02-ra-0030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 06/14/2016] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The purpose of this study was to explore providers' perspectives on the use of a novel technology, "Large Customizable Interactive Monitor" (LCIM), a novel application of the electronic health record system implemented in a Pediatric Intensive Care Unit. METHODS We employed a qualitative approach to collect and analyze data from pediatric intensive care physicians, pediatric nurse practitioners, and acute care specialists. Using semi-structured interviews, we collected data from January to April, 2015. The research team analyzed the transcripts using an iterative coding method to identify common themes. RESULTS Study results highlight contextual data on providers' use routines of the LCIM. Findings from thirty six interviews were classified into three groups: 1) providers' familiarity with the LCIM; 2) providers' use routines (i.e. when and how they use it); and 3) reasons why they use or do not use it. CONCLUSION It is important to conduct baseline studies of the use of novel technologies. The importance of training and orientation affects the adoption and use patterns of this new technology. This study is notable for being the first to investigate a LCIM system, a next generation system implemented in the pediatric critical care setting. Our study revealed this next generation HIT might have great potential for family-centered rounds, team education during rounds, and family education/engagement in their child's health in the patient room. This study also highlights the effect of training and orientation on the adoption patterns of new technology.
Collapse
Affiliation(s)
- Onur Asan
- Onur Asan, PhD, Center for Patient Care and Outcomes Research, Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, Phone: +14149558815, Fax: +14149556689,
| | | | | | | | | | | |
Collapse
|