Breaking News
November 17, 2018 - Tracking Preemies’ Head Size May Yield IQ Clues
November 17, 2018 - Scientists call for unified standards in 3-D genome and epigenetic data
November 17, 2018 - Lab Innovations 2018 has beaten all records by attracting 3,113 attendees
November 17, 2018 - Sexuality education before age 18 may reduce risk of sexual assault in college
November 17, 2018 - Lab Innovations 2018 confirmed as a major hit with visitors, exhibitors and speakers
November 17, 2018 - Largest parasitic worm genetic study hatches novel treatment possibilities
November 17, 2018 - Obesity significantly increases risk of Type 2 diabetes and coronary artery disease
November 17, 2018 - People with rare cancers can benefit from genomic profiling, shows research
November 17, 2018 - NIH awards over $1.8 million to husband-and-wife doctors to test new breast cancer approach
November 17, 2018 - Four-in-one antibody used to fight flu shows promise in mice
November 17, 2018 - New approach allows pathogens to be starved by blocking important enzymes
November 17, 2018 - Higher body mass index could cause depression even without health problems
November 17, 2018 - Protein which plays role in sensing cell damage serves as new target to treat pulmonary hypertension
November 17, 2018 - FDA Approves Adcetris (brentuximab vedotin) in Combination with Chemotherapy for Adults with Previously Untreated Systemic Anaplastic Large Cell Lymphoma or Other CD30-Expressing Peripheral T-Cell Lymphomas
November 17, 2018 - ID specialist input improves outcomes for outpatient parenteral antimicrobial therapy
November 17, 2018 - UT Southwestern scientists selected to receive 2019 Edith and Peter O’Donnell Awards
November 17, 2018 - New clinical algorithm to help individuals manage type 2 diabetes when fasting during Ramadan
November 17, 2018 - Researchers identify LZTR1 as evolutionarily conserved component of RAS pathway
November 17, 2018 - Heart Disease Leading Cause of Death in Low-Income Counties
November 17, 2018 - Estrogen Levels Test: MedlinePlus Lab Test Information
November 17, 2018 - Research reveals link between immunity, diabetes
November 17, 2018 - Research shows how to achieve improved smoking cessation outcomes within California’s Medicaid population
November 17, 2018 - New study finds less understanding and implementation of patient engagement
November 17, 2018 - New shoe insole technology could help diabetic ulcers heal better while walking
November 17, 2018 - New method to extend cell division and immortalization of avian-derived cells
November 17, 2018 - Australian Academy of Science urges parents to vaccinate children against meningococcal disease
November 17, 2018 - Hot water treatment may help improve inflammation and metabolism in sedentary people
November 17, 2018 - Researchers produce 3D chemical maps of small biological samples
November 17, 2018 - Must Blood Pressure Rise Wth Age? Remote Tribes Hold Clues
November 17, 2018 - Noonan Syndrome
November 17, 2018 - Interventions to delay and prevent type 2 diabetes are underused, researchers say
November 17, 2018 - Hackathon prize winner seeks to remotely monitor patient skin conditions
November 17, 2018 - Research team identifies Ashkenazi Jewish founder mutation for Leigh syndrome
November 17, 2018 - Gene editing could be used to halt kidney disease in patients with Joubert syndrome
November 17, 2018 - Study uncovers link between gut disruption and aging
November 17, 2018 - Teens more likely to pick up smoking after exposure from friends and family
November 17, 2018 - Nicoya designate the Institute for Stem Cell Biology and Regenerative Medicine as the OpenSPR Centre of Excellence
November 17, 2018 - new horizon in dental, oral and craniofacial research
November 17, 2018 - How does poor air quality affect your health?
November 17, 2018 - New device can regulate children’s blood glucose more like natural pancreas
November 17, 2018 - Game-Changers in Western Blotting and Protein Analysis
November 17, 2018 - FDA announces new actions to limit sale of e-cigarettes to youth
November 17, 2018 - Warmer winter temperatures related to higher crime rates
November 17, 2018 - MCO places increasing emphasis on helping people find and access healthy food
November 17, 2018 - Group of students aim to improve malaria diagnosis using old smartphones
November 17, 2018 - Transplantation of feces may protect preterm children from deadly bowel disease
November 17, 2018 - Researchers explore whether low-gluten diets can be recommended for people without allergies
November 17, 2018 - New and better marker for assessing patients after cardiac arrest
November 17, 2018 - For 7-year-old with failing bone marrow, a life-saving transplant | News Center
November 17, 2018 - New first-line treatment for peripheral T-cell lymphoma approved by FDA
November 17, 2018 - Artificial intelligence could be valuable tool to help young victims disclose traumatic testimony
November 17, 2018 - Breakthrough in the treatment of Restless Legs Syndrome
November 16, 2018 - FDA Approves Keytruda (pembrolizumab) for the Treatment of Patients with Hepatocellular Carcinoma (HCC) Who Have Been Previously Treated with Sorafenib
November 16, 2018 - Eagle Books | Native Diabetes Wellness Program
November 16, 2018 - Patients with common heart failure more likely to have lethal heart rhythms
November 16, 2018 - How AI could help veterinarians code their notes | News Center
November 16, 2018 - Bias-based bullying does more harm to students than generalized bullying
November 16, 2018 - Researchers find first direct evidence that cerebellum plays role in cognitive functions
November 16, 2018 - Non-coding genetic variant plays key role in endothelial function and disease incidence
November 16, 2018 - EMA recommends first all-oral treatment to tackle deadly sleeping sickness
November 16, 2018 - Drug used to treat dizziness may slow down growth of triple-negative breast cancer
November 16, 2018 - AHA: Icosapent Ethyl Cuts CV Risk From Elevated Triglycerides
November 16, 2018 - ‘Orphan’ RNAs make cancer deadlier, but potentially easier to diagnose
November 16, 2018 - Air Cube touches down at hospital | News Center
November 16, 2018 - CRISPR-based tool shown to enhance cell-based immunotherapy
November 16, 2018 - Mechanisms that govern HIV latency differ in the gut and blood, finds study
November 16, 2018 - Researchers unravel mystery of NPM1 protein in acute myeloid leukemia
November 16, 2018 - High school students less likely to select milk, fruit for lunch when fruit juice is available
November 16, 2018 - Football coaches with great emotional competence are more successful
November 16, 2018 - Researchers awarded $10 million grant to address root causes of asthma in Puerto Rico
November 16, 2018 - Personalized scheduling of radiotherapy using genetic data could reduce side effects
November 16, 2018 - American Cancer Society study links social isolation to higher mortality risk
November 16, 2018 - Health Tip: Manage Morning Sickness
November 16, 2018 - Long term exposure to road traffic noise linked with greater obesity risk
November 16, 2018 - Infant gut microbes altered by mother’s obesity may increase risk for future disease
November 16, 2018 - Immunotherapy combination and chemotherapy show encouraging results in Phase II acute myeloid leukemia study
November 16, 2018 - ACC Latin America Conference brings experts to discuss latest cardiovascular science
November 16, 2018 - Pooled analysis of Intersect ENT’s steroid releasing implants in patients after frontal sinus surgery to be published
November 16, 2018 - Expectations about pain intensity can become self-fulfilling prophecies
November 16, 2018 - NIH awards $3.4 million to UC researchers to study gastrointestinal lymphatic system
Study shows electronic health records leave doctors and patients unsatisfied

Study shows electronic health records leave doctors and patients unsatisfied

image_pdfDownload PDFimage_print

Electronic Health Records are intended to streamline and improve access to information – and have been shown to improve quality of care – but a new study shows they also leave both doctors and patients unsatisfied, even after full implementation.

The study, by researchers at Lehigh University and the Lehigh Valley Health Network, 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 studies looking at how EHR implementation affects provider and patient satisfaction, this is the first study of how the integration of outpatient and hospital EHR systems affects provider and patient satisfaction.

Published in the August print issues 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 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.

Previous to the integrated EHR – digital versions of patient medical records were accessible through computers for some patients and paper records were sent by courier to the hospital for others – 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.

“We wanted to study how the EHR affected information flow between hospitals and practices and we chose pregnancy and obstetrics because it is a well-defined period – the prenatal care, birth and post-natal care all occur in a time frame we can capture,” said Meyerhoefer, who co-authored the paper with Susan A. Sherer, Mary E. Deily, Shin-Yi Chou and Jie Chen of Lehigh University and Michael Sheinberg and Donald Levick of Lehigh Valley Health Network. “In pregnancy, information is very important, having information about the patient’s prenatal experience can help to avert adverse events during the birth.”

Surprising results

Researchers discovered both unsurprising and surprising results.

In theory, while it is understandable that implementation of an EHR would be seen as disruptive initially, by the time the EHR was in regular use, one would expect patients and doctors to report improvements in communication and coordination of care. However, the study showed that even after the EHR was established, both doctors and patients 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.

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.”

Why? Researchers aren’t sure, 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. A previous study by the researchers, which looked at data flow from outpatient ob-gyns to the hospital and back and which information mattered, showed that implementation of an EHR decreased adverse birth events and had a positive effect on birth outcomes.

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.

“It could also be the case that having the computer documentation be a bigger part of patient interactions may be a negative thing for patients,” Meyerhoefer said. “The need for documentation sometimes takes the focus away from having a personal relationship with the patient.”

Training for doctors

“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. This might include training for doctors in how to maintain verbal and nonverbal communication with patients during visits while also collecting or inputting information into a computer.

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.

In addition to patient experiences, the impacts are important to study and consider because installation of an EHR generally changes the way doctors and staff record and report information, as well as work processes and staffing related to documentation. “It can be a big change, and can be very disruptive,” Meyerhoefer said. Acquiring EHR software is typically a large financial investment for a hospital or health system as well. And even after a system is acquired and used, replacing it with a new system would engender similar adoption issues.

“These findings are specific to ob-gyn patients, but I think these results on satisfaction would carry over to many other types of care, where physicians and other clinical providers will not really see the benefit of a system until the information flow is improved, and there can be persistent negative effects on patient satisfaction,” Meyerhoefer said.

Tagged with:

About author

Related Articles