Impact of an electronic medical record system on community-based primary care practices (original) (raw)
Related papers
Journal of General Internal Medicine, 2013
The use of electronic health records (EHR) is widely recommended as a means to improve the quality, safety and efficiency of US healthcare. Relatively little is known, however, about how implementation and use of this technology affects the work of clinicians and support staff who provide primary health care in small, independent practices. To study the impact of EHR use on clinician and staff work burden in small, community-based primary care practices. We conducted in-depth field research in seven community-based primary care practices. A team of field researchers spent 9-14 days over a 4-8 week period observing work in each practice, following patients through the practices, conducting interviews with key informants, and collecting documents and photographs. Field research data were coded and analyzed by a multidisciplinary research team, using a grounded theory approach. All practice members and selected patients in seven community-based primary care practices in the Northeastern US. The impact of EHR use on work burden differed for clinicians compared to support staff. EHR use reduced both clerical and clinical staff work burden by improving how they check in and room patients, how they chart their work, and how they communicate with both patients and providers. In contrast, EHR use reduced some clinician work (i.e., prescribing, some lab-related tasks, and communication within the office), while increasing other work (i.e., charting, chronic disease and preventive care tasks, and some lab-related tasks). Thoughtful implementation and strategic workflow redesign can mitigate the disproportionate EHR-related work burden for clinicians, as well as facilitate population-based care. The complex needs of the primary care clinician should be understood and considered as the next iteration of EHR systems are developed and implemented.
Implementation of an electronic medical record in family practice: a case study
2010
Background Electronic medical records (EMRs) have the potential to foster a safer, more effective and more efficient healthcare system. However, their implementation in primary care practice remains a challenge. Objective This study aims at exploring factors that have influenced the successful implementation of an EMR system in a family medicine group (FMG) in the Province of Québec, Canada. Methods A case study approach was selected to get a deep understanding of the phenomenon in its context. The case was chosen on the basis that it was the first FMG in Québec to implement a full EMR used by all clinicians. Fifteen semi-structured interviews were conducted with key informants. Results Factors that have influenced the success of the EMR implementation were classified under three broad themes: a project leader who combined the roles of clinical, technology and knowledge champion; an organisation that was open to and supportive of change; and an evidence-based implementation strategy tailored to the local context and adoption pace. Conclusions This study underscores the importance of a champion for successful EMR implementation. It proposes a set of roles and characteristics that could be found in a champion as well as other elements for a successful EMR implementation strategy.
Implementation Science, 2008
Background: Implementing change in primary care is difficult, and little practical guidance is available to assist small primary care practices. Methods to structure care and develop new roles are often needed to implement an evidence-based practice that improves care. This study explored the process of change used to implement clinical guidelines for primary and secondary prevention of cardiovascular disease in primary care practices that used a common electronic medical record (EMR).
Health Affairs, 2011
The incentives in the American Recovery and Reinvestment Act to expand the "meaningful use" of electronic health record systems have many health care professionals searching for information about the cost and staff resources that such systems require. We report the cost of implementing an electronic health record system in twenty-six primary care practices in a physician network in north Texas, taking into account hardware and software costs, as well as the time and effort invested in implementation. For an average five-physician practice, implementation cost an estimated 162,000,with162,000, with 162,000,with85,500 in maintenance expenses during the first year. We also estimate that the HealthTexas network implementation team and the practice implementation team needed 611 hours, on average, to prepare for and implement the electronic health record system, and that "end users"-physicians, other clinical staff, and nonclinical staff-needed 134 hours per physician, on average, to prepare for use of the record system in clinical encounters.
Electronic health records in small physician practices: availability, use, and perceived benefits
Journal of the American Medical Informatics Association, 2011
Objective To examine variation in the adoption of electronic health record (EHR) functionalities and their use patterns, barriers to adoption, and perceived benefits by physician practice size. Design Mailed survey of a nationally representative random sample of practicing physicians identified from the Physician Masterfile of the American Medical Association. Measurements We measured, stratified by practice size: (1) availability of EHR functionalities, (2) functionality use, (3) barriers to the adoption and use of EHR, and (4) impact of the EHR on the practice and quality of patient care. Results With a response rate of 62%, we found that <2% of physicians in solo or two-physician (small) practices reported a fully functional EHR and 5% reported a basic EHR compared with 13% of physicians from 11+ group (largest group) practices with a fully functional system and 26% with a basic system. Between groups, a 21e46% difference in specific functionalities available was reported. Among adopters there were moderate to large differences in the use of the EHR systems. Financial barriers were more likely to be reported by smaller practices, along with concerns about future obsolescence. These differences were sizable (13e16%) and statistically significant (p<0.001). All adopters reported similar benefits. Limitations Although we have adjusted for response bias, influences may still exist. Conclusion Our study found that physicians in small practices have lower levels of EHR adoption and that these providers were less likely to use these systems. Ensuring that unique barriers are addressed will be critical to the widespread meaningful use of EHR systems among small practices.
2015
Electronic health records (EHRs) are one of the most talked about topics within and surrounding health care organizations and the health care system in the United States; however, the U.S. has been slow to implement these computerized medical record systems into their organizations. One of the factors often overlooked regarding the implementation of EHRs, is the role of individual health care professionals and the effects produced by their interactions with the EHR as they perform their job duties throughout the day. Using a Theory of Organization-EHR Affordance Actualization as a guiding framework, the focus of this dissertation is to examine the factors that influence how physicians use the EHR at the individual-level during clinical interactions by analyzing physician perceptions of their interaction with the EHR while providing patient care in the exam room and how it influences their work process. A mixed methods approach was used to identify the affordances, EHR features, fact...
Implementation of an electronic health records system in a small clinic: The view of clinic staff
2009
In this study, we examined the implementation of an electronic health records (EHR) system in a small family practice clinic. We used three data collection instruments to evaluate user experience, work pattern changes, and organisational changes related to the implementation and use of the EHR system: (1) an EHR user survey, (2) interviews with key personnel involved in the EHR implementation project, and (3) a work analysis of clinic staff. A longitudinal design with two data-collection rounds was employed: data were collected prior to EHR implementation and after EHR implementation. Both quantitative and qualitative data were collected and analysed. Employees of the small clinic perceived few changes in their work after the implementation of the EHR system, except for increased dependency on computers and a small increase in perceived workload. The work analysis showed a dramatic increase in the amount of time spent on computers by the various job categories. The EHR implementatio...
The electronic elephant in the room: Physicians and the electronic health record
JAMIA Open
Objectives Determine the specific aspects of health information and communications technologies (HICT), including electronic health records (EHRs), most associated with physician burnout, and identify effective coping strategies. Materials and methods We performed a qualitative analysis of transcripts from 2 focus groups and a burnout assessment of ambulatory physicians—each at 3 different health care institutions with 3 different EHRs. Results Of the 41 clinicians, 71% were women, 98% were physicians, and 73% worked in primary care for an average of 11 years. Only 22% indicated sufficient time for documentation. Fifty-six percent noted “a great deal of stress” because of their job. Forty-two percent reported “poor” or “marginal” control over workload. Even though 90% reported EHR proficiency, 56% indicated EHR time at home was “excessive” or “moderately high.” Focus group themes included HICT “successes” where all patients’ information is accessible from multiple locations. HICT “s...