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Abstract

Introduction: Morning rounds in the Intensive Care Unit (ICU) are an important platform for formulating a daily plan of care. The availability of an electronic medical record (EMR) is anticipated to improve health care quality, advance patient safety and reduce waste. It is increasingly recognized that providers with access to an EMR spend a significant amount of time in passive activities (e.g. data gathering, presentation) rather than active patient engagement. A novel user interface was developed by a multidisciplinary ICU team to better manage information available within the EMR with the objective of reducing the amount of time spent on low level tasks such as data gathering. The purpose of this paper is to assess the perceptions of providers to the introduction of this enhancement of the existing EMR. Hypothesis: A novel user interface, designed around the information needs of ICU providers will improve satisfaction with the EMR. Methods: Between March 26, 2012 and June 3, 2012 the novel user interface was introduced in a stepped wedge cluster randomized trial conducted in four ICUs at a tertiary medical center. ICU providers (Attending physicians, clinical fellows, residents, interns, nurses and respiratory therapists) were asked to complete a modified version of a previously validated, questionnaire designed to capture various aspects of provider perception with either the standard EMR or EMR enhanced with the novel user interface. Surveys were presented to providers around the time of ICU morning rounds. A Likert scale was used to assess user perceptions (1 strongly disagree to 5 strongly agree). Mean and standard deviation (mean± SD) were used to compare each question between pre and post surveys. Results: A total of 36 providers, (response rate 86%) and 25 providers (response rate 86%) competed the pre and post implementation surveys respectively. There was a significant difference in 7 out of the 10 survey questions, (EMR v novel user interface) as follows; information was available in a timely fashion (mean± SD, p value) (3.3 ± 1.02 vs. 3.9 ± 0.81, P <0.001); information was up to date (3.7 ± 0.85 vs. 4.1 ± 0.79, P<0.001); information was accurate (4.0 ± 0.75 vs. 3.8 ± 0.86, P 0.01); information was presented in a useful format (2.7 ± 1.08 vs. 4.0 ± 0.93, P<0.001); presented information was clear (3.2 ± 0.98 vs. 4.1 ± 0.62, P <0.001), data gathering was difficult (2.1 ± 0.83 vs. 3.39 ± 1.12, P<0.001) and data was mentally demanding (2.1 ± 0.86 vs. 3.17 ± 1.14, P<0.001). Conclusions: A locally designed and implemented novel user interface improved ICU providers’ satisfaction with the EMR.