Technology versus humanism: how patients perceive the use of electronic health records in physicians' offices--a qualitative study

Revolutionizing decision support: a systematic literature review of contextual implementation models for electronic health records systems

PURPOSE

This study aims to assess previously developed Electronic Health Records System (EHRS) implementation models and identify successful models for decision support.

DESIGN/METHODOLOGY/APPROACH

A systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The data sources used were Scopus, PubMed and Google Scholar. The review identified peer-reviewed papers published in the English Language from January 2010 to April 2023, targeting well-defined implementation of EHRS with decision-support capabilities in healthcare. To comprehensively address the research question, we ensured that all potential sources of evidence were considered, and quantitative and qualitative studies reporting primary data and systematic review studies that directly addressed the research question were included in the review. By including these studies in our analysis, we aimed to provide a more thorough and reliable evaluation of the available evidence.

FINDINGS

The findings suggest that the success of EHRS implementation is determined by organizational and human factors rather than technical factors alone. Successful implementation is dependent on a suitable implementation framework and management of EHRS. The review identified the capabilities of Clinical Decision Support (CDS) tools as essential in the effectiveness of EHRS in supporting decision-making.

ORIGINALITY/VALUE

This study contributes to the existing literature on EHRS implementation models and identifies successful models for decision support. The findings can inform future implementations and guide decision-making in healthcare facilities.

Effect of digitization of medical case files on doctor patient relationship in an Out Patient Department setting of Northern India: A comparative study

Background: Digitization of health records and health delivery processes in health care settings may have an impact on the Patient-Physician communication, wait times, that affect the overall patient satisfaction with the health care services. Aim & Objective: We ascertained the effect of digitization of medical case files on the doctor patient relationship (DPR) domain of patient satisfaction at an urban primary health center in India. Settings and Design: Comparative, cross-sectional study in primary health centres. Methods and Material: The patient satisfaction was compared between the patients attending the Public Health Dispensary (PHD) that uses digitized medical case file system and a Civil Dispensary (CD) which follows the conventional paper based medical records, using a Patient Satisfaction Questionnaire (PSQ). Statistical analysis used: Univariate analysis was done by chi-square test and adjusted analysis was done by multiple linear regression. Results: Patient satisfaction in DPR was found to be same between the digitized medical case files based and conventional OPD (p=0.453). Significantly higher overall patient satisfaction was reported in the conventional paper based OPD than the digitized OPD (p<0.001). Conclusions: Patient satisfaction towards the doctor-patient relationship (DPR) was same between paper based OPD and the digitized medical case files based OPD.

Paving the way for increased e-health record use: elaborating intentions of Gen-Z

This paper presents the determinants of personal e-health records adoption by the Gen-Z population and reveals barriers to use. Gen-Z members are one of the most prominent users of digital health services that have an influence on older generations' technology adoption but have often been overlooked in scholarly research. A survey of 1,000 Gen-Z university students based on modified UTAUT was used to address this research gap. The analysis revealed the vital role of social influence in paving the way for higher adoption among Gen-Z. Moreover, significant influences of performance expectancy, facilitating conditions, and e-health literacy on behavioural intentions were detected. Effort expectancy was found to be insignificant in impacting Gen-Z's intentions to adopt electronic health record systems. Moreover, privacy concerns acted as a barrier to adoption, yet the offsetting effect of users' trust in health systems was shown to be instrumental in overcoming such privacy-related barriers.

Electronic Health Record Transition: The Patient Experience

Use of the EHR at the bedside is now commonplace, and some fear this may compromise their relationship with the patient. The purpose of this study was to assess the impact of a transition of an EHR on the patient experience. Three non-equivalent groups consisting of 55 patients responded to instrument questions at three distinct time points: baseline prior to transition and twice after the transition at 6 weeks and 6 months. Questions investigated the point-of-care computer use, user's comfort, and impact on patient relationship with a nurse or provider. Patients perceived more use of the computer by Nurses and a declining use by Others. Nurses remained comfortable using the computer over time, and the perception of Others declined. Nurses were perceived 2.3 times more likely than Others as changing the patient relationship and two times higher with a positive impact. The transition in the EHR did not seem to affect the overall patient experience; however, results should be viewed with caution given the limitations of this study and the dearth of evidence. Evidence-based guidelines for EHR integration may be helpful in the future to address inpatient encounters with all clinicians.

Substance Use Stigma, Primary Care, and the New York State Prescription Drug Monitoring Program

Prescription drug monitoring programs (PDMPs) are databases that track controlled substances at the provider, patient, and pharmacy levels. While these databases are widely available at the state level throughout the United States, several jurisdictions in recent years have mandated the use of these systems by health care providers. This study explores the implementation of mandatory PDMP technology in primary care practice and the effects on treatment of people with possible substance use disorders. Findings are based on 53 in-depth interviews with primary care providers in New York City, collected shortly following the passage of legislation mandating use of a PDMP by health care providers in New York State. Findings suggest that use of the PDMP highlighted tensions between provider stigma toward substance use disorders and the clinical care of people who use drugs, challenging their stereotypes and biases. The parallel clinical and law enforcement purposes of PDMP technology placed providers in dual roles as clinicians and enforcers and encouraged the punitive treatment of patients. Finally, PDMP technology standardized the clinical assessment process toward a "diagnosis first" approach, consistent with prior scholarship on the implementation of emerging medical technologies.

Making Electronic Health Records (EHRs) Work: Informal Talk and Workarounds in Healthcare Organizations

A key provision of the American Recovery and Reinvestment Act of 2009 mandated that electronic health records (EHR) be adopted in US healthcare organizations by 2015. The purpose of this study is to examine the communicative processes involved as healthcare workers implement an EHR and make changes, known as workarounds. Guided by theories in social influence, and diffusion of innovations, we conducted a survey of healthcare professionals using an EHR system in an organization. Our structural equation modeling (SEM) and multiple regression results reveal coworker communication, in the form of informal social support and feedback, play an important role in whether people engage in workarounds. Understanding this relationship is important because our study also demonstrates that workarounds predict healthcare employees' overall satisfaction with the EHR system. Specifically, workarounds are associated with higher perceptions of the EHR's relative advantage, higher perceptions of EHR implementation success, and lower levels of resistance to EHR change. This study offers a health communication contribution to the growing research on EHR systems and demonstrates the persuasive effects that coworkers have on new technology use in healthcare organizations.