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Krishnan L, Neuss M. Virtuosic craft or clerical labour: the rise of the electronic health record and challenges to physicians' professional identity (1950-2022). MEDICAL HUMANITIES 2022:medhum-2022-012404. [PMID: 36207060 DOI: 10.1136/medhum-2022-012404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/18/2022] [Indexed: 06/16/2023]
Abstract
The electronic health record (EHR) is a focus of contentious debate, having become as essential to contemporary clinical practice as it is polarising. Debates about the EHR raise questions about physicians' professional identity, the nature of clinical work, evolution of the patient/practitioner relationship, and narratives of technological optimism and pessimism. The metaphors by which clinicians stake our identities-are we historians, detectives, educators, technicians, or something else?-animate the history of the early computer-based medical record in the mid-to-late twentieth-century USA. Proponents and detractors were equally interested in what the EHR revealed about clinician identity, and how it might fundamentally reshape it. This paper follows key moments in the history of the early computer-based patient record from the late 1950s to the EHR of the present day. In linking physician identity development, clinical epistemological structures, and the rise of the computer-based medical record in the USA in the mid-to-late twentieth century, we ask why the EHR is such a polarising entity in contemporary medicine, and situate clinician/EHR tensions in a longer history of aspirational physician identity and a kind of technological optimism that soon gave way to pessimism surrounding computer-based clinical work.
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Affiliation(s)
- Lakshmi Krishnan
- Department of Medicine, Georgetown University, Washington, District of Columbia, USA
- Medical Humanities Initiative, Georgetown University, Washington, District of Columbia, USA
- Department of English, Georgetown University, Washington, District of Columbia, USA
| | - Michael Neuss
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Colicchio TK, Liang WH, Dissanayake PI, Do Rosario CV, Cimino JJ. Physicians' perceptions about a semantically integrated display for chart review: A Multi-Specialty survey. Int J Med Inform 2022; 163:104788. [DOI: 10.1016/j.ijmedinf.2022.104788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/25/2022]
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Nguyen OT, Turner K, Apathy NC, Magoc T, Hanna K, Merlo LJ, Harle CA, Thompson LA, Berner ES, Feldman SS. Primary care physicians' electronic health record proficiency and efficiency behaviors and time interacting with electronic health records: a quantile regression analysis. J Am Med Inform Assoc 2021; 29:461-471. [PMID: 34897493 PMCID: PMC8800512 DOI: 10.1093/jamia/ocab272] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/05/2021] [Accepted: 11/23/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE This study aimed to understand the association between primary care physician (PCP) proficiency with the electronic health record (EHR) system and time spent interacting with the EHR. MATERIALS AND METHODS We examined the use of EHR proficiency tools among PCPs at one large academic health system using EHR-derived measures of clinician EHR proficiency and efficiency. Our main predictors were the use of EHR proficiency tools and our outcomes focused on 4 measures assessing time spent in the EHR: (1) total time spent interacting with the EHR, (2) time spent outside scheduled clinical hours, (3) time spent documenting, and (4) time spent on inbox management. We conducted multivariable quantile regression models with fixed effects for physician-level factors and time in order to identify factors that were independently associated with time spent in the EHR. RESULTS Across 441 primary care physicians, we found mixed associations between certain EHR proficiency behaviors and time spent in the EHR. Across EHR activities studied, QuickActions, SmartPhrases, and documentation length were positively associated with increased time spent in the EHR. Models also showed a greater amount of help from team members in note writing was associated with less time spent in the EHR and documenting. DISCUSSION Examining the prevalence of EHR proficiency behaviors may suggest targeted areas for initial and ongoing EHR training. Although documentation behaviors are key areas for training, team-based models for documentation and inbox management require further study. CONCLUSIONS A nuanced association exists between physician EHR proficiency and time spent in the EHR.
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Affiliation(s)
- Oliver T Nguyen
- Corresponding Author: Oliver T. Nguyen, MSHI, Department of Community Health and Family Medicine, University of Florida, College of Medicine, PO Box 100211, Gainesville, FL 32610, USA;
| | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA,Department of Oncological Sciences, University of South Florida, Tampa, Florida, USA
| | - Nate C Apathy
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tanja Magoc
- Clinical and Translational Science Institute, University of Florida, Gainesville, Florida, USA
| | - Karim Hanna
- Department of Family Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Lisa J Merlo
- Department of Psychiatry, University of Florida, Gainesville, Florida, USA
| | - Christopher A Harle
- Clinical and Translational Science Institute, University of Florida, Gainesville, Florida, USA,Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Lindsay A Thompson
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA,Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Eta S Berner
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sue S Feldman
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama, USA
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