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Why patients and doctors are still dissatisfied by electronic health records

Physicians were less satisfied by the system overall, citing the time it took to enter data, changes to workflow and decreased productivity.

Jeff Lagasse, Associate Editor

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 can also leave both doctors and patients unsatisfied, even after full implementation.

Takeaways for health professionals: During EHR implementations, or even once the system is in full swing, keep in mind how patients will be affected -- and perhaps even do training on patient interactions with EHRs to mitigate some of the negative effects. 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.

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.

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Researchers 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. OB-GYN practices posed a good opportunity for study because typically a woman will see physicians at her practice multiple times during 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.

Researchers discovered both surprising and unsurprising 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. But 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.

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.

The research team wasn't sure why that 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. 

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.

Twitter: @JELagasse
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