Disrupted and Restored Patient Experience With Transition to New Electronic Health Record System

Transitioning from one electronic health record (EHR) system to another is of the most disruptive events in health care and research about its impact on patient experience for inpatient is limited. This study aimed to assess the impact of transitioning EHR on patient experience measured by the Hospital Consumer Assessment of Healthcare Providers and Systems composites and global items. An interrupted time series study was conducted to evaluate quarter-specific changes in patient experience following implementation of a new EHR at a Midwest health care system during 2017 to 2018. First quarter post-implementation was associated with statistically significant decreases in Communication with Nurses (−1.82; 95% CI, −3.22 to −0.43; P = .0101), Responsiveness of Hospital Staff (−2.73; 95% CI, −4.90 to −0.57; P = .0131), Care Transition (−2.01; 95% CI, −3.96 to −0.07; P = .0426), and Recommend the Hospital (−2.42; 95% CI, −4.36 to −0.49; P = .0142). No statistically significant changes were observed in the transition, second, or third quarters post-implementation. Patient experience scores returned to baseline level after two quarters and the impact from EHR transition appeared to be temporary.

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Implementation and evaluation of Stanford Health Care store-and-forward teledermatology consultation workflow built within an existing electronic health record system

Journal of Telemedicine and Telecare ◽

10.1177/1357633x18799805 ◽

2018 ◽

Vol 26 (3) ◽

pp. 125-131 ◽

Cited By ~ 5

Author(s):

Grace E Kim ◽

Olga K Afanasiev ◽

Chris O’Dell ◽

Christopher Sharp ◽

Justin M Ko

Keyword(s):

Health Care ◽

Electronic Health Record ◽

Primary Care Physicians ◽

Health Record ◽

Record System ◽

Privacy Concerns ◽

Successful Model ◽

Dermatology Clinic ◽

Electronic Health ◽

Store And Forward

Introduction Teledermatology services that function separately from patients’ primary electronic health record (EHR) can lead to fragmented care, poor provider communication, privacy concerns and billing challenges. This study addresses these challenges by developing PhotoCareMD, a store-and-forward (SAF) teledermatology consultation workflow built entirely within an existing Epic-based EHR. Methods Thirty-six primary care physicians (PCPs) from eight outpatient clinics submitted 215 electronic consults (eConsults) for 211 patients to a Stanford Health Care dermatologist via PhotoCareMD. Comparisons were made with in-person referrals for this same dermatologist prior to initiation of PhotoCareMD. Results Compared to traditional in-person dermatology clinic visits, eConsults decreased the time to diagnosis and treatment from 23 days to 16 hours. The majority (73%) of eConsults were resolved electronically. In-person referrals from PhotoCareMD (27%) had a 50% lower cancellation rate compared with traditional referrals (11% versus 22%). The average in-person visit and documentation was 25 minutes compared with 8 minutes for an eConsult. PhotoCareMD saved 13 additional clinic hours to be made available to the dermatologist over the course of the pilot. At four patients per hour, this opens 52 dermatology clinic slots. Over 96% of patients had a favourable experience and 95% felt this service saved them time. Among PCPs, 100% would recommend PhotoCareMD to their colleagues and 95% said PhotoCareMD was a helpful educational tool. Discussion An internal SAF teledermatology workflow can be effectively implemented to increase access to and quality of dermatologic care. Our workflow can serve as a successful model for other hospitals and specialties.

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Beyond Getting Rid of Stupid Stuff in the Electronic Health Record (Beyond-GROSS): Protocol for a User-Centered, Mixed-Method Intervention to Improve the Electronic Health Record System

JMIR Research Protocols ◽

10.2196/25148 ◽

2021 ◽

Vol 10 (3) ◽

pp. e25148

Author(s):

Ahmed Umar Otokiti ◽

Catherine K Craven ◽

Avniel Shetreat-Klein ◽

Stacey Cohen ◽

Bruce Darrow

Keyword(s):

Health Care ◽

Data Analysis ◽

Electronic Health Record ◽

Health Record ◽

User Centered Design ◽

Pilot Phase ◽

Direct Input ◽

Electronic Health ◽

The Impact ◽

User Centered

Background Up to 60% of health care providers experience one or more symptoms of burnout. Perceived clinician burden resulting in burnout arises from factors such as electronic health record (EHR) usability or lack thereof, perceived loss of autonomy, and documentation burden leading to less clinical time with patients. Burnout can have detrimental effects on health care quality and contributes to increased medical errors, decreased patient satisfaction, substance use, workforce attrition, and suicide. Objective This project aims to improve the user-centered design of the EHR by obtaining direct input from clinicians about deficiencies. Fixing identified deficiencies via user-centered design has the potential to improve usability, thereby increasing satisfaction by reducing EHR-induced burnout. Methods Quantitative and qualitative data will be obtained from clinician EHR users. The input will be received through a form built in a REDCap database via a link embedded in the home page of the EHR. The REDCap data will be analyzed in 2 main dimensions, based on nature of the input, what section of the EHR is affected, and what is required to fix the issue(s). Identified issues will be escalated to relevant stakeholders responsible for rectifying the problems identified. Data analysis, project evaluation, and lessons learned from the evaluation will be incorporated in a Plan-Do-Study-Act (PDSA) manner every 4-6 weeks. Results The pilot phase of the study began in October 2020 in the Gastroenterology Division at Mount Sinai Hospital, New York City, NY, which includes 39 physicians and 15 nurses. The pilot is expected to run over a 4-6–month period. The results of the REDCap data analysis will be reported within 1 month of completing the pilot phase. We will analyze the nature of requests received and the impact of rectified issues on the clinician EHR user. We expect that the results will reveal which sections of the EHR have the highest deficiencies while also highlighting issues about workflow difficulties. Perceived impact of the project on provider engagement, patient safety, and workflow efficiency will also be captured by evaluation survey and other qualitative methods where possible. Conclusions The project aims to improve user-centered design of the EHR by soliciting direct input from clinician EHR users. The ultimate goal is to improve efficiency, reduce EHR inefficiencies with the possibility of improving staff engagement, and lessen EHR-induced clinician burnout. Our project implementation includes using informatics expertise to achieve the desired state of a learning health system as recommended by the National Academy of Medicine as we facilitate feedback loops and rapid cycles of improvement. International Registered Report Identifier (IRRID) PRR1-10.2196/25148

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Users' Satisfaction with the Electronic Health Record (EHR) in the Kingdom of Bahrain

International Journal of E-Health and Medical Communications ◽

10.4018/ijehmc.2016070103 ◽

2016 ◽

Vol 7 (3) ◽

pp. 29-51

Author(s):

Aysha Ebrahim Abdulla ◽

Shurooq Yousif Ahmed ◽

Maryam Abdulrahman Alnoaimi ◽

Hayat Ali

Keyword(s):

Service Quality ◽

Electronic Health Record ◽

Online Survey ◽

Healthcare Providers ◽

Health Sector ◽

Public Hospitals ◽

Health Record ◽

Record System ◽

Substantial Impact ◽

Electronic Health

Today, many hospitals seek to adopt the latest and most sophisticated technologies in order to raise the service quality and users' satisfaction. The Electronic Health Record (EHR) had a substantial impact on the health sector and has enhanced the efficiency and effectiveness of healthcare providers. The purpose of this research is to examine the factors that affect users' satisfaction with the current Health Record System in the Kingdom of Bahrain. A research model was built based on three popular models of users' satisfaction toward information systems. Toward achieving the research objective, a quantitative approach was followed to collect data from an online survey. Accordingly, 152 responses were collected from the users of EHR in public hospitals and health centres in Bahrain. The results of the survey were analyzed using SPSS and SmartPLS 3.0. It was concluded that the most effective factors in the users' satisfaction with EHR were directly service quality and technical support, with system and information quality indirectly through trust.

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Assessment of Data Quality of and Staff Satisfaction with an Electronic Health Record System in a Developing Country (Uganda)

Methods of Information in Medicine ◽

10.3414/me0511 ◽

2008 ◽

Vol 47 (06) ◽

pp. 489-498 ◽

Cited By ~ 13

Author(s):

S.P. Ndira ◽

K.D. Rosenberger ◽

T. Wetter

Keyword(s):

Electronic Health Record ◽

Quantitative Methods ◽

Electronic System ◽

Hospital Staff ◽

Health Record ◽

Staff Satisfaction ◽

District Health ◽

Record System ◽

Post Test ◽

Electronic Health

Summary Objectives: To assess if electronic health record systems in developing countries can improve on timeliness, availability and accuracy of routine health reports and staff satisfaction after introducing the electronic system, compared to the paper-based alternative. Methods: The research was conducted with hospital staff of Tororo District Hospital in Uganda. A comparative intervention study with qualitative and quantitative methods was used to compare the paper-based (pre-test) to the electronic system (post-test) focusing on accuracy, availability and timeliness of monthly routine reports about mothers visiting the hospital; and staff satisfaction with the electronic system as outcome measures. Results: Timeliness: pre-test 13 of 19 months delivered to the district timely, delivery dates for six months could not be established; post-test 100%. Availability: pretest 79% of reports were present at the district health office; post-test 100%. Accuracy: pre-test 73.2% of selected reports could be independently confirmed as correct; post-test 71.2%. Difficulties were encountered in finding enough mothers through direct follow up to inquire on accuracy of information recorded about them. Staff interviews showed that the electronic system is appreciated by the majority of the hospital staff. Remaining obstacles include staff workload, power shortages, network breakdowns and parallel data entry (paper-based and electronic). Conclusion: While timeliness and availability improved, improvement of accuracy could not be established. Better approaches to ascertaining accuracy have to be devised, e.g. evaluation of intended use. For success, organizational, managerial and social challenges must be addressed beyond technical aspects.

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How well is the electronic health record supporting the clinical tasks of hospital physicians? A survey of physicians at three Norwegian hospitals

BMC Health Services Research ◽

10.1186/s12913-019-4763-0 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Thomas Roger Schopf ◽

Bente Nedrebø ◽

Karl Ove Hufthammer ◽

Inderjit Kaur Daphu ◽

Hallvard Lærum

Keyword(s):

Health Care ◽

Electronic Health Record ◽

Electronic Health Record System ◽

System Stability ◽

Medical Decision ◽

Health Record ◽

Clinical Workflow ◽

Online Questionnaire ◽

Record System ◽

Electronic Health

Abstract Background The electronic health record is expected to improve the quality and efficiency of health care. Many novel functionalities have been introduced in order to improve medical decision making and communication between health care personnel. There is however limited evidence on whether these new functionalities are useful. The aim of our study was to investigate how well the electronic health record system supports physicians in performing basic clinical tasks. Methods Physicians of three prominent Norwegian hospitals participated in the survey. They were asked, in an online questionnaire, how well the hospital’s electronic health record system DIPS supported 49 clinical tasks as well as how satisfied they were with the system in general, including the technical performance. Two hundred and eight of 402 physicians (52%) submitted a completely answered questionnaire. Results Seventy-two percent of the physicians had their work interrupted or delayed because the electronic health record hangs or crashes at least once a week, while 22% had experienced this problem daily. Fifty-three percent of the physicians indicated that the electronic health record is cumbersome to use and adds to their workload. The majority of physicians were satisfied with managing tests, e.g., requesting laboratory tests, reading test results and managing radiological investigations and electrocardiograms. Physicians were less satisfied with managing referrals. There was high satisfaction with some of the decision support functionalities available for prescribing drugs. This includes drug interaction alerts and drug allergy warnings, which are displayed automatically. However, physicians were less satisfied with other aspects of prescribing drugs, including getting an overview of the ongoing drug therapy. Conclusions In the survey physicians asked for improvements of certain electronic health record functionalities like medication, clinical workflow support including planning and better overviews. In addition, there is apparently a need to focus on system stability, number of logins, reliability and better instructions on available electronic health record features. Considerable development is needed in current electronic health record systems to improve usefulness and satisfaction.

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Completeness of doctor note in electronic health record system in primary health care unit

Annals of Tropical Medicine and Public Health ◽

10.4103/1755-6783.205566 ◽

2017 ◽

Vol 10 (1) ◽

pp. 274

Author(s):

Won Sriwijittala ◽

Viroj Wiwanitkit

Keyword(s):

Health Care ◽

Primary Health Care ◽

Electronic Health Record ◽

Electronic Health Record System ◽

Health Record ◽

Record System ◽

Primary Health ◽

Health Care Unit ◽

Electronic Health

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Nurses’ characteristics and perceptions toward using the electronic health record system as predictors of clinical nursing performance improvement

Clinical Nursing Studies ◽

10.5430/cns.v5n4p32 ◽

2017 ◽

Vol 5 (4) ◽

pp. 32

Author(s):

Ahmad H. Abu Raddaha

Keyword(s):

Nursing Education ◽

Electronic Health Record ◽

Technology Use ◽

Work Performance ◽

Health Record ◽

Sampling Frame ◽

Record System ◽

Clinical Nursing ◽

Electronic Health ◽

The Impact

Objective: Little and inconclusive knowledge is known about nurses’ perceptions toward electronic health record (EHR) systems and how nurses role performance has been affected after using such systems. This study assessed the relationships between nurses’ sociodemographic characteristics, history and pattern of computer technology use, and perceptions toward the EHR system with their perceptions regarding improvement of clinical nursing performance after using the system. Predictors of nurses’ perception regarding the effect of the EHR system on improving their clinical nursing performance were delineated.Methods: Descriptive correlational design was used. A standardized self-administered questionnaire was used to collect data from nurses working at a governmental teaching hospital in Muscat, Oman. Nurses were selected randomly from a sampling frame, which consisted of a comprehensive list of employment numbers of nurses at the hospital.Results: With a response rate of 84.5%, 169 nurses returned completed questionnaires. The majority had highly positive perceptions toward the EHR system. A weakly negative correlation was observed between perceiving that EHR system is improving work performance with increasing level of academic nursing education (rho = 0.17, p = .02). Nurses who reported that it was easy to know how to request a test, record etc. using the EHR system [OR: 3.89 (95% CI: 1.54, 9.87), p < .01] were more likely perceive the EHR system as an improver to their clinical nursing performance. While, nurses who had completed at least baccalaureate nursing education [OR: 0.41 (95% CI: 0.19, 0.89), p = .02] were less likely to perceive the EHR system had improved their performance.Conclusions: Nurses should be able to demonstrate basic nursing informatics competencies when dealing with computers and software applications used in healthcare settings. Future qualitative studies are encouraged to explore the lived experiences of nurses, in order to develop better understanding to the impact of the EHR system on nursing practice.

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Implementing an Open Source Electronic Health Record System in Kenyan Health Care Facilities: Case Study (Preprint)

10.2196/preprints.8403 ◽

2017 ◽

Author(s):

Naomi Muinga ◽

Steve Magare ◽

Jonathan Monda ◽

Onesmus Kamau ◽

Stuart Houston ◽

...

Keyword(s):

Health Care ◽

Electronic Health Record ◽

Open Source ◽

Health Information ◽

Health Care Facilities ◽

Health Record ◽

Record System ◽

Care Facilities ◽

Electronic Health

BACKGROUND The Kenyan government, working with international partners and local organizations, has developed an eHealth strategy, specified standards, and guidelines for electronic health record adoption in public hospitals and implemented two major health information technology projects: District Health Information Software Version 2, for collating national health care indicators and a rollout of the KenyaEMR and International Quality Care Health Management Information Systems, for managing 600 HIV clinics across the country. Following these projects, a modified version of the Open Medical Record System electronic health record was specified and developed to fulfill the clinical and administrative requirements of health care facilities operated by devolved counties in Kenya and to automate the process of collating health care indicators and entering them into the District Health Information Software Version 2 system. OBJECTIVE We aimed to present a descriptive case study of the implementation of an open source electronic health record system in public health care facilities in Kenya. METHODS We conducted a landscape review of existing literature concerning eHealth policies and electronic health record development in Kenya. Following initial discussions with the Ministry of Health, the World Health Organization, and implementing partners, we conducted a series of visits to implementing sites to conduct semistructured individual interviews and group discussions with stakeholders to produce a historical case study of the implementation. RESULTS This case study describes how consultants based in Kenya, working with developers in India and project stakeholders, implemented the new system into several public hospitals in a county in rural Kenya. The implementation process included upgrading the hospital information technology infrastructure, training users, and attempting to garner administrative and clinical buy-in for adoption of the system. The initial deployment was ultimately scaled back due to a complex mix of sociotechnical and administrative issues. Learning from these early challenges, the system is now being redesigned and prepared for deployment in 6 new counties across Kenya. CONCLUSIONS Implementing electronic health record systems is a challenging process in high-income settings. In low-income settings, such as Kenya, open source software may offer some respite from the high costs of software licensing, but the familiar challenges of clinical and administration buy-in, the need to adequately train users, and the need for the provision of ongoing technical support are common across the North-South divide. Strategies such as creating local support teams, using local development resources, ensuring end user buy-in, and rolling out in smaller facilities before larger hospitals are being incorporated into the project. These are positive developments to help maintain momentum as the project continues. Further integration with existing open source communities could help ongoing development and implementations of the project. We hope this case study will provide some lessons and guidance for other challenging implementations of electronic health record systems as they continue across Africa.

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