Int J Med Inform - The impact of electronic medical record systems on outpatient workflows: a longitudinal evaluation of its workflow effects.

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Resumo

NTEXT: The promise of the electronic medical record (EMR) lies in its ability to reduce the costs of health care delivery and improve the overall quality of care--a promise that is realized through major changes in workflows within the health care organization. Yet little systematic information exists about the workflow effects of EMRs. Moreover, some of the research to-date points to reduced satisfaction among physicians after implementation of the EMR and increased time, i.e., negative workflow effects. A better understanding of the impact of the EMR on workflows is, hence, vital to understanding what the technology really does offer that is new and unique.OBJECTIVE: (i) To empirically develop a physician centric conceptual model of the workflow effects of EMRs; (ii) To use the model to understand the antecedents to the physicians' workflow expectation from the new EMR; (iii) To track physicians' satisfaction overtime, 3 months and 20 months after implementation of the EMR; (iv) To explore the impact of technology learning curves on physicians' reported satisfaction levels.DESIGN: The current research uses the mixed-method technique of concept mapping to empirically develop the conceptual model of an EMR's workflow effects. The model is then used within a controlled study to track physician expectations from a new EMR system as well as their assessments of the EMR's performance 3 months and 20 months after implementation.SETTING: The research tracks the actual implementation of a new EMR within the outpatient clinics of a large northeastern research hospital.PARTICIPANTS: The pre-implementation survey netted 20 physician responses; post-implementation Time 1 survey netted 22 responses, and Time 2 survey netted 26 physician responses.INTERVENTION: The implementation of the actual EMR served as the intervention. Since the study was conducted within the same setting and tracked a homogenous group of respondents, the overall study design ensured against extraneous influences on the results.MAIN OUTCOME MEASURES: Outcome measures were derived empirically from the conceptual model. They included 85 items that measured physician perceptions of the EMR's workflow effect on the following eight issues: (1) administration, (2) efficiency in patient processing, (3) basic clinical processes, (4) documentation of patient encounter, (5) economic challenges and reimbursement, (6) technical issues, (7) patient safety and care, and (8) communication and confidentiality. The items were used to track expectations prior to implementation and they served as retrospective measures of satisfaction with the EMR in post-implementation Time 1 and Time 2.RESULTS: The findings suggest that physicians conceptualize EMRs as an incremental extension of older computerized provider order entries (CPOEs) rather than as a new innovation. The EMRs major functional advantages are seen to be very similar to, if not the same as, those of CPOEs. Technology learning curves play a statistically significant though minor role in shaping physician perceptions.CONCLUSIONS: The physicians' expectations from the EMR are based on their prior beliefs rather than on a rational evaluation of the EMR's fit, functionality, or performance. Their decision regarding the usefulness of the EMR is made very early, within the first few months of use of the EMR. These early perceptions then remain stable and become the lens through which subsequent experience with the EMR is interpreted. The findings suggest a need for communication based interventions aimed at explaining the value, fit, and usefulness of EMRs to physicians early in the pre- and immediate post-EMR implementation stages.

Resumo Limpo

ntext promis electron medic record emr lie abil reduc cost health care deliveri improv overal qualiti carea promis realiz major chang workflow within health care organ yet littl systemat inform exist workflow effect emr moreov research todat point reduc satisfact among physician implement emr increas time ie negat workflow effect better understand impact emr workflow henc vital understand technolog realli offer new uniqueobject empir develop physician centric conceptu model workflow effect emr ii use model understand anteced physician workflow expect new emr iii track physician satisfact overtim month month implement emr iv explor impact technolog learn curv physician report satisfact levelsdesign current research use mixedmethod techniqu concept map empir develop conceptu model emr workflow effect model use within control studi track physician expect new emr system well assess emr perform month month implementationset research track actual implement new emr within outpati clinic larg northeastern research hospitalparticip preimplement survey net physician respons postimplement time survey net respons time survey net physician responsesintervent implement actual emr serv intervent sinc studi conduct within set track homogen group respond overal studi design ensur extran influenc resultsmain outcom measur outcom measur deriv empir conceptu model includ item measur physician percept emr workflow effect follow eight issu administr effici patient process basic clinic process document patient encount econom challeng reimburs technic issu patient safeti care communic confidenti item use track expect prior implement serv retrospect measur satisfact emr postimplement time time result find suggest physician conceptu emr increment extens older computer provid order entri cpoe rather new innov emr major function advantag seen similar cpoe technolog learn curv play statist signific though minor role shape physician perceptionsconclus physician expect emr base prior belief rather ration evalu emr fit function perform decis regard use emr made earli within first month use emr earli percept remain stabl becom len subsequ experi emr interpret find suggest need communic base intervent aim explain valu fit use emr physician earli pre immedi postemr implement stage

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