EHR Implementation in a New Clinic: A Case Study of Clinician Perceptions

Abstract

Driven by the Health Information Technology for Economic and Clinical Health (HITECH) Act large numbers of physicians and hospitals are now implementing electronic health records (EHR) with the general expectation that such systems will improve the quality, safety and efficiency of health care services. Studies of conversions from paper to electronic records paint a mixed picture with healthcare providers pleased with some aspects of their EHRs but dissatisfied with others. These prior studies focused on conversions from paper to electronic records. Many provider impressions, therefore, may have been influenced by reactions to the process of being required to change well established patterns. In order to help separate such reactions from true evaluations of the efficacy of the EHR, we decided to survey the providers in a new health center. To insure that the information gathered was not merely anecdotal, we used a well-established format starting with a semi-structured interview which facilitates analysis and recognition of major themes. We included questions around several important areas including workflow, communication, patient satisfaction, productivity, documentation, and quality of care. Ten main themes emerged: impeding patient flow, hindering communication in office, improving communication after the visit, improving tracking of patient care, spending less time with patients, requiring more training, wanting more features, diminishing productivity, appreciating benefits of templates, and enhancing internal communication. The need for better training appeared to be of especially high importance as it impacted several of the other themes. We believe that our study helps validate the similar concerns expressed in studies of transitions from paper to electronic record systems. Our method may be generally useful to other clinics because it facilitates timely recognition of themes, both positive and negative, that clinicians and clinic managers would want to know at an early stage. Prompt knowledge of such developing themes may help to accentuate the positive aspects of the EHR and to prevent negative themes from developing into serious problems that might be considered serious unintended consequences of EHR usage.

Towards a Conceptual Framework for Persistent Use: A Technical Plan to Achieve Semantic Interoperability within Electronic Health Record Systems

“…An analysis of the articles compiled for the literature review provides a conclusion that the implementation of a viable EHR interoperability solution would involve significant factors of data standardization and translation which will allow for the exploration of: (a) the current healthcare based standards of EHR interoperability [18], [20], [31], [1], [4]; (b) technical infrastructure which focuses on the back-end infrastructure [2], [19]; (c) modification and optimal changes in process and workflows which consider the current operational practices [7], [14], [22]; and (d) how existing EHR interoperability solutions are implemented [24], [29], [30].…”

“…Another research study conducted by [24] focused on the factors related to the reluctance of physicians and hospitals to implement electronic health record systems for the purpose of patient data sharing and exchange. The slow implementation of EHR systems is directly related to the reluctance by the physicians and facilities to begin using the systems.…”

“…However, it was further explained that once the system is adopted, the users expressed satisfaction, citing "improved quality, safety, communication, and access" to patient data. [24] also noted that the providers' impressions of converting from paper to electronic management of patient data may have been influenced by reactions to the fact that many previous studies have indicated that they will be required to change some of their wellestablished patterns of operation. The study, therefore, focused on the efficacy of EHR implementation by evaluating the reactions of providers at a new health center.…”

Electronic Health Record Implementation Strategies

“…However, scholars such as continue to work toward solutions to the challenges. Noblin et al (2013) argued that increased numbers of physicians and hospital administrators implementing EHRs assume that the systems will contribute to enhanced safety, efficiency and improved quality of care. As noted, research is replete with analysis indicating that system designs will continue to evolve and continue to garner the beneficial aspects of EHR.…”

“…Although the United States is a highly industrialized nation, the United States remains behind other countries in developing an interoperable EHR infrastructure (Sao, Gupta, & Gantz, 2013). Among the obstacles to the implementation of EHR systems are underdeveloped infrastructure and widespread concerns of consumers and medical professionals about privacy and security safeguards (Noblin et al, 2013). Technology and information systems abound in the United States, yet standardized, interoperable EHR systems provided by competing proprietary vendors are costly and could undermine patient centeredness (Zhang et al, 2016).…”