A Qualitative Study of Physician Perspectives on Adaptation to Electronic Health Records

Medical Center ◽

Academic Medical Center ◽

Opportunity To Learn ◽

Structured Interviews ◽

Health Records ◽

Physician Perspectives ◽

Academic Medical ◽

Abstract Background Electronic Health Records (EHRs) have the potential to improve many aspects of care and their use has increased in the last decade. Because of this, acceptance and adoption of EHRs is less of a concern than adaptation to use. To understand this issue more deeply, we conducted a qualitative study of physician perspectives on EHR use to identify factors that facilitate adaptation.Methods We conducted semi-structured interviews with 9 physicians across a range of inpatient disciplines at a large Academic Medical Center. Interviews were conducted by phone, lasting approximately 30 minutes, and were transcribed verbatim for analysis. We utilized inductive and deductive methods in our analysis.Results We identified 4 major themes related to EHR adapation: impact of EHR changes on physicians, how physicians managed these changes, factors that facilitated adapation to using the EHR and adapting to using the EHR in the patient encounter. Within these themes, physicians felt that a positive mindset toward change, providing upgrade training that was tailored to their role, and the opportunity to learn from colleagues were important facilitators of adaption.Conclusions As EHR use moves beyond implementation, physicians continue to be required to adapt to the technology and to its frequent changes. Our study provides actionable findings that allow healthcare systems to focus on factors that facilitate the adaptation process for physicians.

A Qualitative Study of Physician Perspectives on Adaptation to Electronic Health Records

10.21203/rs.2.13132/v2 ◽

2019 ◽

Author(s):

Cynthia Judine Sieck ◽

Nicole Pearl ◽

Tiffani J. Bright ◽

Po-Yin Yen

Keyword(s):

Qualitative Study ◽

Medical Center ◽

Academic Medical Center ◽

Opportunity To Learn ◽

Structured Interviews ◽

Health Records ◽

Physician Perspectives ◽

Academic Medical ◽

Abstract Background Electronic Health Records (EHRs) have the potential to improve many aspects of care and their use has increased in the last decade. Because of this, acceptance and adoption of EHRs is less of a concern than adaptation to use. To understand this issue more deeply, we conducted a qualitative study of physician perspectives on EHR use to identify factors that facilitate adaptation.Methods We conducted semi-structured interviews with 9 physicians across a range of inpatient disciplines at a large Academic Medical Center. Interviews were conducted by phone, lasting approximately 30 minutes, and were transcribed verbatim for analysis. We utilized inductive and deductive methods in our analysis.Results We identified 4 major themes related to EHR adapation: impact of EHR changes on physicians, how physicians managed these changes, factors that facilitated adapation to using the EHR and adapting to using the EHR in the patient encounter. Within these themes, physicians felt that a positive mindset toward change, providing upgrade training that was tailored to their role, and the opportunity to learn from colleagues were important facilitators of adaption.Conclusions As EHR use moves beyond implementation, physicians continue to be required to adapt to the technology and to its frequent changes. Our study provides actionable findings that allow healthcare systems to focus on factors that facilitate the adaptation process for physicians.

A qualitative study of physician perspectives on adaptation to electronic health records

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-020-1030-6 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Cynthia J. Sieck ◽

Nicole Pearl ◽

Tiffani J. Bright ◽

Po-Yin Yen

Keyword(s):

Qualitative Study ◽

Health Records ◽

Physician Perspectives ◽

Awareness of the Care Team in Electronic Health Records

Applied Clinical Informatics ◽

10.4338/aci-2011-05-ra-0034 ◽

2011 ◽

Vol 02 (04) ◽

pp. 395-405 ◽

Cited By ~ 21

Author(s):

L.G. Wilcox ◽

S. Collins ◽

S. Feiner ◽

O. Mamykina ◽

D.M. Stein ◽

...

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Physician Assistants ◽

Care Team ◽

Accurate Information ◽

Care Providers ◽

Health Records ◽

Electronic Health ◽

Attending Physicians

SummaryObjective: To support collaboration and clinician-targeted decision support, electronic health records (EHRs) must contain accurate information about patients’ care providers. The objective of this study was to evaluate two approaches for care provider identification employed within a commercial EHR at a large academic medical center.Methods: We performed a retrospective review of EHR data for 121 patients in two cardiology wards during a four-week period. System audit logs of chart accesses were analyzed to identify the clinicians who were likely participating in the patients’ hospital care. The audit log data were compared with two functions in the EHR for documenting care team membership: 1) a vendor-supplied module called “Care Providers”, and 2) a custom “Designate Provider” order that was created primarily to improve accuracy of the attending physician of record documentation.Results: For patients with a 3–5 day hospital stay, an average of 30.8 clinicians accessed the electronic chart, including 10.2 nurses, 1.4 attending physicians, 2.3 residents, and 5.4 physician assistants. The Care Providers module identified 2.7 clinicians/patient (1.8 attending physicians and 0.9 nurses). The Designate Provider order identified 2.1 clinicians/patient (1.1 attending physicians, 0.2 resident physicians, and 0.8 physician assistants). Information about other members of patients’ care teams (social workers, dietitians, pharmacists, etc.) was absent.Conclusions: The two methods for specifying care team information failed to identify numerous individuals involved in patients’ care, suggesting that commercial EHRs may not provide adequate tools for care team designation. Improvements to EHR tools could foster greater collaboration among care teams and reduce communication-related risks to patient safety.

Oncologists’ Views Regarding the Role of Electronic Health Records in Care Coordination

JCO Clinical Cancer Informatics ◽

10.1200/cci.17.00118 ◽

2018 ◽

pp. 1-12 ◽

Cited By ~ 6

Author(s):

Onur Asan ◽

Ann B. Nattinger ◽

Ayse P. Gurses ◽

Jeanne T. Tyszka ◽

Tina W.F. Yen

Keyword(s):

Care Coordination ◽

Information Transfer ◽

Medical Center ◽

Academic Medical Center ◽

Unintended Consequences ◽

Safety Hazards ◽

Health Records ◽

Electronic Health ◽

Oncology Providers

Background Electronic health records (EHRs) play a significant role in complex health care processes, especially in information transfer with patients and care coordination among providers. EHRs may also generate unintended consequences, introducing new patient safety risks. To date, little investigation has been performed in oncology settings, despite the need for quality provider-patient communication and information transfer during oncology visits. In this qualitative study, we focused on oncology providers’ perceptions of EHRs for supporting communication with patients and coordination of care with other providers. Methods We conducted semistructured interviews with oncologists from an urban academic medical center to learn their perceptions of the use of EHRs before, during, and after clinic visits with patients. Our interview guide was developed on the basis of the work system model. We coded transcripts using inductive content analysis. Results Data analysis yielded four main themes regarding oncologists’ practices in using the EHR and perceptions about EHRs: (1) EHR use for care coordination (eg, timeliness of receiving information, SmartSet documentation); (2) EHR use in the clinic visit (eg, educating patients, using as a reinforcement tool); (3) safety hazards in care coordination associated with EHRs (eg, incomplete documentation, error propagating, no filtering mechanism to capture errors); and (4) suggestions for improvements (eg, improved SmartSet functionalities, simplification of user interface). Conclusion Current EHRs do not adequately support teamwork of oncology providers, which could lead to potential hazards in the care of patients with cancer. Redesigning EHR features that are tailored to support oncology care and addressing the concerns regarding information overload, improved organization of flagging abnormal results, and documentation-related workload are needed to minimize potential safety hazards.

The Postencounter Form System: Viewpoint on Efficient Data Collection Within Electronic Health Records (Preprint)

10.2196/preprints.17429 ◽

2019 ◽

Author(s):

Philip Held ◽

Randy A Boley ◽

Walter G Faig ◽

John A O'Toole ◽

Imran Desai ◽

...

Keyword(s):

Medical Center ◽

Health Records ◽

Clinical Notes ◽

The Road ◽

Clinical Encounters ◽

Efficient Data ◽

Data Points ◽

Electronic Health ◽

Using Data

UNSTRUCTURED Electronic health records (EHRs) offer opportunities for research and improvements in patient care. However, challenges exist in using data from EHRs due to the volume of information existing within clinical notes, which can be labor intensive and costly to transform into usable data with existing strategies. This case report details the collaborative development and implementation of the postencounter form (PEF) system into the EHR at the Road Home Program at Rush University Medical Center in Chicago, IL to address these concerns with limited burden to clinical workflows. The PEF system proved to be an effective tool with over 98% of all clinical encounters including a completed PEF within 5 months of implementation. In addition, the system has generated over 325,188 unique, readily-accessible data points in under 4 years of use. The PEF system has since been deployed to other settings demonstrating that the system may have broader clinical utility.

Patient Involvement in Anesthesia Decision-making: A Qualitative Study of Knee Arthroplasty

Anesthesiology ◽

10.1097/aln.0000000000003795 ◽

2021 ◽

Author(s):

Veena Graff ◽

Justin T. Clapp ◽

Sarah J. Heins ◽

Jamison J. Chung ◽

Madhavi Muralidharan ◽

...

Keyword(s):

Decision Making ◽

Qualitative Study ◽

Shared Decision Making ◽

Knee Arthroplasty ◽

Patient Involvement ◽

Medical Center ◽

Academic Medical Center ◽

Shared Decision ◽

Structured Interviews ◽

Primary Knee Arthroplasty

Background Calls to better involve patients in decisions about anesthesia—e.g., through shared decision-making—are intensifying. However, several features of anesthesia consultation make it unclear how patients should participate in decisions. Evaluating the feasibility and desirability of carrying out shared decision-making in anesthesia requires better understanding of preoperative conversations. The objective of this qualitative study was to characterize how preoperative consultations for primary knee arthroplasty arrived at decisions about primary anesthesia. Methods This focused ethnography was performed at a U.S. academic medical center. The authors audio-recorded consultations of 36 primary knee arthroplasty patients with eight anesthesiologists. Patients and anesthesiologists also participated in semi-structured interviews. Consultation and interview transcripts were coded in an iterative process to develop an explanation of how anesthesiologists and patients made decisions about primary anesthesia. Results The authors found variation across accounts of anesthesiologists and patients as to whether the consultation was a collaborative decision-making scenario or simply meant to inform patients. Consultations displayed a number of decision-making patterns, from the anesthesiologist not disclosing options to the anesthesiologist strictly adhering to a position of equipoise; however, most consultations fell between these poles, with the anesthesiologist presenting options, recommending one, and persuading hesitant patients to accept it. Anesthesiologists made patients feel more comfortable with their proposed approach through extensive comparisons to more familiar experiences. Conclusions Anesthesia consultations are multifaceted encounters that serve several functions. In some cases, the involvement of patients in determining the anesthetic approach might not be the most important of these functions. Broad consideration should be given to both the applicability and feasibility of shared decision-making in anesthesia consultation. The potential benefits of interventions designed to enhance patient involvement in decision-making should be weighed against their potential to pull anesthesiologists’ attention away from important humanistic aspects of communication such as decreasing patients’ anxiety. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Understanding optimisation processes of electronic health records (EHRs) in select leading hospitals: a qualitative study

BMJ Health & Care Informatics ◽

10.14236/jhi.v25i2.1011 ◽

2018 ◽

Vol 25 (2) ◽

pp. 109-125 ◽

Cited By ~ 5

Author(s):

Mark Chun Moon ◽

Rebecca Hills ◽

George Demiris

Keyword(s):

United States ◽

Qualitative Study ◽

Hospital Setting ◽

The United States ◽

Theory Approach ◽

Health Records ◽

High Performing ◽

Advisory Groups ◽

BackgroundLittle is known about optimisation of electronic health records (EHRs) systems in the hospital setting while adoption of EHR systems continues in the United States.ObjectiveTo understand optimisation processes of EHR systems undertaken in leading healthcare organisations in the United States.MethodsInformed by a grounded theory approach, a qualitative study was undertaken that involved 11 in-depth interviews and a focus group with the EHR experts from the high performing healthcare organisations across the United States.ResultsThe study describes EHR optimisation processes characterised by prioritising exponentially increasing requests with predominant focus on improving efficiency of EHR, building optimisation teams or advisory groups and standardisation. The study discusses 16 types of optimisation that interdependently produced 16 results along with identifying 11 barriers and 20 facilitators to optimisation.ConclusionsThe study describes overall experiences of optimising EHRs in select high performing healthcare organisations in the US. The findings highlight the importance of optimising the EHR after, and even before, go-live and dedicating resources exclusively for optimisation.

Barriers and facilitators to data quality of electronic health records used for clinical research in China: a qualitative study

BMJ Open ◽

10.1136/bmjopen-2019-029314 ◽

2019 ◽

Vol 9 (7) ◽

pp. e029314 ◽

Cited By ~ 2

Author(s):

Kaiwen Ni ◽

Hongling Chu ◽

Lin Zeng ◽

Nan Li ◽

Yiming Zhao

Keyword(s):

Qualitative Study ◽

Clinical Research ◽

Data Quality ◽

Healthcare Professionals ◽

Barriers And Facilitators ◽

Health Records ◽

Improve Data Quality ◽

ObjectivesThere is an increasing trend in the use of electronic health records (EHRs) for clinical research. However, more knowledge is needed on how to assure and improve data quality. This study aimed to explore healthcare professionals’ experiences and perceptions of barriers and facilitators of data quality of EHR-based studies in the Chinese context.SettingFour tertiary hospitals in Beijing, China.ParticipantsNineteen healthcare professionals with experience in using EHR data for clinical research participated in the study.MethodsA qualitative study based on face-to-face semistructured interviews was conducted from March to July 2018. The interviews were audiorecorded and transcribed verbatim. Data analysis was performed using the inductive thematic analysis approach.ResultsThe main themes included factors related to healthcare systems, clinical documentation, EHR systems and researchers. The perceived barriers to data quality included heavy workload, staff rotations, lack of detailed information for specific research, variations in terminology, limited retrieval capabilities, large amounts of unstructured data, challenges with patient identification and matching, problems with data extraction and unfamiliar with data quality assessment. To improve data quality, suggestions from participants included: better staff training, providing monetary incentives, performing daily data verification, improving software functionality and coding structures as well as enhancing multidisciplinary cooperation.ConclusionsThese results provide a basis to begin to address current barriers and ultimately to improve validity and generalisability of research findings in China.