Even after full implementation, electronic health records (EHRs) are leaving doctors and patients unsatisfied, according to a new study.
The study, by researchers at Lehigh University and the Lehigh Valley Health Network in Pennsylvania, surveyed physicians, mid-level providers and non-clinical staff at ob-gyn practices where EHRs were installed and analyzed survey answers given by patients. While there have been several studies looking at how EHR implementation affects provider and patient satisfaction, the researchers attest that this is the first study of how the integration of outpatient and hospital EHR systems affects provider and patient satisfaction.
Published in the Journal of the American Medical Informatics Association, the study tracked two ob-gyn practices and a regional hospital from 2009 to 2013, during implementation of an EHR system and its subsequent integration with the hospital system. The EHR was installed in 2009 and information began flowing from the hospital to the ob-gyn practices in mid-2011. Full two-way exchange of clinical information was achieved a year later.Ob-gyn practices posed a uniquely good opportunity for study, because typically a woman will see physicians at her ob-gyn practice multiple times during the pregnancy before being admitted for labor (often seeing different doctors), and on average will have at least one pregnancy-related hospital visit prior to giving birth at a hospital, co-author Chad Meyerhoefer, professor of economics at Lehigh University, said.
Before EHRs existed, versions of patient medical records were accessible through computers for some patients and paper records were sent by courier to the hospital for others. But transmission of such records often was not made between hospitals and outpatient practices in a timely manner. This meant physicians at the practices might not know about visits to the hospital or test results ordered there and hospital doctors would not have access to the woman's prior clinical data from outpatient ob-gyn appointments during visits to the hospital's perinatal triage unit, the researchers noted.
While initial frustrations are expected after an implementation, researchers in this study found that even after the EHR was established, both doctors and patients still expressed dissatisfaction. In the early stages, doctors and staff expressed frustration at learning a new system and the time it took to enter information. By the end of the study, staff appreciated ease with retrieving information and doctors felt communication and care were improved. Doctors, however, were also less satisfied by the system overall, citing the time it took to enter data, changes to workflow and decreased productivity.
"It was more of an adjustment for physicians, as it required them to do additional documentation they didn't have to do before, and it had a bigger impact on their workflow," Meyerhoefer said.
Meanwhile, patients felt the disruption at the beginning, and continued to feel less satisfied with their experiences after the EHR was fully implemented and was being used. "Our thought was after the system was implemented and some time had passed, and all these new capabilities are added to the system, the patients would see the benefits of that and feel better about their visits," Meyerhoefer said. "But that didn't happen."
Researchers are not exactly sure why this was the case, but one aspect may be that patients would likely have been unaware of improvements to their care and outcomes as a result of the EHR and may not have considered that when describing satisfaction levels, Meyerhoefer said.
Changes in administrative practices, documentation, staffing, staff work roles and stress, and doctors' concerns about productivity goals related to the implementation may also have changed the patient experience, or a patient's perception of the care experience, in ways patients didn't like, the researchers hypothesized.
"The takeaway message is that during these implementations, or after you have the system in place, you have to really think about how this is going to affect patients and maybe do training on patient interactions with electronic medical records to head off some of these negative effects," Meyerhoefer said. Also, since the brunt of documentation impact falls to physicians and impacts productivity, adjustments should be made to productivity targets that take that into consideration, researchers said.
