Electronic Medical Record Users Research Articles

Understanding Adoption of Electronic Medical Records (EMRs) during a Health Emergency: An Analysis of EMR Usage Logs from Rural Health Facilities in the Philippines

Understanding Adoption of Electronic Medical Records (EMRs) during a Health Emergency: An Analysis of EMR Usage Logs from Rural Health Facilities in the Philippines

Kepuasan Pengguna Sistem Informasi Rekam Medis Elektronik RSUD Tugurejo

Evaluation of user satisfaction of Electronic Medical Record (EMR) system users can be considered by hospitals in developing EMR systems. Tugurejo Hospital has implemented EMR both outpatient and inpatient. Quantitative research is conducted to determine user satisfaction. The respondents were 67 users of EMR from doctors and nurses. EMR user satisfaction according to Delone and McLean's IT/IS Success Model theory was analyzed using SMART-PLS to determine how strong the influence of system quality, information quality and service quality on EMR user satisfaction. The results showed that user satisfaction was influenced by system quality (T-stat = 2.96), information quality (T-stat = 1.66), service quality (T-stat = 1.84). There is a mutual influence between system quality, information quality and service quality on user satisfaction with strong categories (R-square = 0.748).

Implementation of Electronic Medical Records at Primary Care in Semarang City Region: An Analysis of Individual and Organisational Determinants

Implementing electronic medical records (EMR) in Puskesmas faces various challenges and barriers that hinder system users. This study aims to identify the effects of individual and organizational factors on the implementation of EMR in Puskesmas located in Semarang City. The study was designed as a cross-sectional study and was conducted between August and September 2023. Participants were selected from five health centres representing five regions of Semarang city, and included 46 health professionals, including physicians, nurses, midwives, medical record keepers and IT staff. The survey was taken from a standardized questionnaire based on the Technology Acceptance Theory and Institutional Theory. The results showed that 34% of the respondents were between 20 and 30 years old, where 76.1% were female and 52.2% had a bachelor's degree, and were dominated by nurses, where the majority had 1-5 years of experience. The constant (a) of 1.770 indicates the value of the independent variables in increasing EMR usage. The regression coefficient of the individual factor variable of 0.207 has a positive effect on EMR implementation. Organisational factors negatively affect the implementation of EMR use. The test results found that individual factors partially and significantly (0.005 <0.05) affect the implementation of EMR utilised.

Exploring maturity of electronic medical record use among allied health professionals.

Electronic medical records (EMRs) have the potential to improve and streamline the quality and safety of patient care. Harnessing the full benefits of EMR implementation depends on the utilisation of advanced features, defined as "mature usage." At present, little is known about the maturity of EMR usage by allied health professionals (AHPs). To examine current maturity of EMR use by AHPs and explore perceived barriers to mature EMR utilisation and optimisation. AHPs were recruited from three health services. Participants completed a 27-question electronic questionnaire based on the EMR Adoption Framework, which measures clinician EMR utilisation (0 = paper chart, 5 = theoretical maximum) across 10 EMR feature categories. Interviews were conducted with both clinicians and managers to explore the nature of current EMR utilisation and perceived facilitators and barriers to mature usage. Questionnaire responses were obtained from 192 AHPs. The majority of questions (74%) showed a mean score of <3, indicating a lack of mature EMR use. Pockets of mature usage were identified in the categories of health information, referrals and administration processes. Interviews with 18 clinicians and managers revealed barriers to optimisation across three themes: (1) limited understanding of EMR opportunities; (2) complexity of the EMR change process and (3) end-user and environmental factors. Mature usage across EMR feature categories of the EMR Adoption Framework was low. However, questionnaire and qualitative interview data suggested pockets of mature utilisation. Achieving mature allied health EMR use will require strategies implemented at the clinician, EMR support, and service levels.

The digital divide: Racial disparities in adoption and utilization of health information technology among patients with lymphoid cancers.

Health information technology (HIT) has the potential to improve healthcare delivery and engagement. Studying racial-ethnic disparities in HIT engagement will help understand and overcome challenges to healthcare utilization. We undertook a patient-reported survey among patients with lymphoid malignancies at two campuses of Mayo Clinic, Florida to explore HIT-related disparities. Variables between Whites and non-Whites, and non-Whites from the two campuses were compared. The survey was completed by 1004 respondents, with 71% whites, 27% non-Whites (race-ethnicity not reported by 2%). Non-Whites included 30% responders at the main campus and 64% at an inner-city campus. Whites were significantly older and had higher education, while non-Whites had lesser access to a computer. Only 51% of non-Whites were registered to use electronic medical records (EMR) as compared to 72% Whites (p < 0.001) and significantly lesser number of non-Whites even knew that EMR existed (81% vs. 92%, p < 0.001). Encouragingly, a higher number of non-Whites wanted to engage in EMR. Non-Whites from the main campus were older, more educated and had more access to a computer as compared to those from the inner-city campus. Similar disparate factors were noted among minorities from the two campuses, suggesting impact of socioeconomic backgrounds on EMR usage among non-Whites. Linguistic barriers were more striking among inner-city campus non-Whites. Non-Whites continue to struggle with suboptimal utilization of the healthcare system and barriers related to integration in HIT, including disparities representing socioeconomic differences. Efforts need to be made at several levels to help racial-ethnic minorities overcome awareness, access, and linguistic barriers to HIT utilization.

Usability Study of an Electronic Medical Record From the Nurse Practitioners' Practice: A Qualitative Study Using the Think-Aloud Technique.

Ensuring the usability of electronic medical records (EMRs) is crucial for healthcare providers to offer efficient, effective, and safe patient care. Nurse practitioners (NPs) are integral to the healthcare system and are essential in managing patient workflows. However, few studies assess NPs' perspectives on how EMR usage affects workflow and patient care quality. In this study, the "think-aloud technique" was utilized for usability testing. It involves observing users (NPs) as they complete their everyday tasks on the EMR while vocalizing their thoughts and emotions. This method has been proven reliable and valid through various research, such as a systematic review. The EMR system used by NPs can create a heavy cognitive workload, have limited functionality, can lead to unintended errors, and may experience technical difficulties. The EMR system used by NPs is challenging due to three main issues: high cognitive workload, limited system functionality, and technical problems. To improve the system, it is recommended to reduce the cognitive burden by customizing the user interface to fit the NPs' needs, enhancing the system's functionality by adding essential features and fixing any technical issues.

Racial and Ethnic Differences in the Use of Electronic Medical Record Messaging Among Patients With Breast Cancer: A Quality Improvement Study

IntroductionDespite evidence that use of electronic medical record (EMR) messaging positively impacts patients with cancer, there is little research on utilization patterns. The objective of this study is to describe the use of EMR messaging among breast cancer patients so that future interventions may be developed and targeted appropriately. Materials and MethodsSociodemographic and MyChart usage data were collected. Study eligibility included patients who completed a visit at an academic breast center and sent at least one message to a provider during the study period (May 2021-May 2022). Chi-square and t-tests were used to describe differences between users and nonusers of EMR messaging. ANOVA and chi-square were used to describe differences between race/ethnicity. ResultsA total of 4069 patients with activated MyChart accounts were included in the analysis. About 3575 (87.9%) were messaging users and 494 (12.1%) were nonusers. The mean age of users was significantly lower compared to the nonusers (57.7 vs 61.2, P< .001). Compared to non-Hispanic White (NHW) individuals, non-Hispanic Black (NHB) (odds ratio [OR]: 0.38, CI [0.21, 0.37]) and Hispanic individuals (OR: 0.35, CI [0.22, 0.57]) were significantly less likely to use electronic messaging. There were statistically significant racial/ethnic differences in the types of messages sent among EMR users. ConclusionOur study shows disparate EMR messaging utilization based on age, race, and primary language. As the availability of patient portals and electronic messaging increase, it is important to understand the barriers that patients face so that they can be addressed.

Experience of introducing electronic health records station in an objective structured clinical examination to evaluate medical students' communication skills in Canada: a descriptive study.

There is limited literature related to the assessment of electronic medical record (EMR)-related competencies. To address this gap, this study aims to explore the feasibility of EMR objective structured clinical examination (OSCE) station to evaluate the medical students' communication skills by psychometric study and standardized patients' (SPs) perspectives on EMR use in OSCE. An OSCE station that incorporated the use of an EMR was developed and pilot-tested in March 2022. Students' communication skills were assessed by SPs and physician examiners. Student's score in EMR station was compared with that of other 9 stations. Psychometric analysis, including item total correlation was done. SPs participated in a post-OSCE focus group to discuss their perception of EMRs' effect on communication. Ninety-nine 3rd year medical students participated in a 10-station OSCE that included the use of the EMR station. The EMR station had an acceptable item total correlation (0.217). Students who leveraged graphical displays in counseling received higher OSCE station scores from the SPs (P -value). Thematic analysis of the SP perception of students' EMR use from the focus group revealed the following domains of themes: technology, communication, case design, ownership of health information, and timing of EMR usage. This study demonstrated the feasibility of incorporating EMR in assessing learner communication skills in an OSCE. The EMR station had acceptable psychometric characteristics. Some medical students were able to efficiently use the EMRs as an aide in patient counseling. Teaching students how to be patient-centred even in the presence of technology may help with engagement.

National survey of user-reported usability of electronic medical record software in ophthalmology in Germany.

A nationwide, comparative survey of the physician-reported usability of electronic medical record (EMR) software used by ophthalmologists in Germany using the System Usability Scale (SUS) as a standardized metric. A cross-sectional survey of members of the German Ophthalmological Society (DOG) and professional association of ophthalmologists (BVA) was conducted in May 2022. All 7788 physician members of both societies were invited to participate in an anonymous online-survey by individualized links. User-reported usability of the participants main software used for electronic medical recordkeeping was assessed using the SUS (range 0-100). A total of 881 participants with 51 different EMRs completed the entire questionnaire. Mean EMR-SUS score was 65.7 (SD ± 23.5). Significant differences in mean SUS of several EMR programs were observed with a range of 31.5 to 87.2 in programs with 10 or more responses. 31.8% of all main program SUS ratings were below 50 points. Female gender was associated with 4.02 higher SUS score (95% CI 0.46-7.59). Main program SUS was positively correlated with overall work-related satisfaction and work environment SUS but negatively correlated with the number of programs in the work environment. The SUS of the entire digital work environment including all programs used daily was closely correlated with the main EMR SUS, but not the number of programs used. Our survey revealed a fragmented pattern of EMR use by ophthalmologists in Germany with many competing software products and widely diverging mean System Usability Scale scores. A considerable share of ophthalmologists report EMR usability below what is commonly considered acceptable.

User Satisfaction of Using Electronic Medical Record System and Its Associated Factors among Healthcare Professionals in Ethiopia: A Cross-Sectional Study

Electronic medical record (EMR) systems have become essential for the proper management of patients' information. Electronic medical record systems are on the rise in developing countries due to the need to ensure improved quality of healthcare. However, EMR systems can be ignored, if users are not satisfied with the implemented system. User dissatisfaction has been associated with the failure of EMR systems as a primary factor. There is also limited research done in the Ethiopian context on EMR user satisfaction at private hospitals. This study is aimed at assessing user satisfaction with electronic medical records and associated factors among health professionals working at private hospitals in Addis Ababa. Institution-based cross-sectional quantitative study was conducted among health professionals working at private hospitals in Addis Ababa, from March to April 2021. A self-administered questionnaire was used to collect the data. EpiData version 4.6 and Stata version 25 were used for data entry and analysis, respectively. Descriptive analyses were computed for the study variables. Bivariable and multivariable logistic regression analyses were carried out to assess the significance of independent variables on dependent variables. A total of 403 (95.33% response rate) participants completed all the questionnaires. More than half of 214 (53.10%) of the participants were satisfied with the EMR system. Factors associated with user satisfaction with electronic medical records were good computer literacy (AOR = 2.92, 95% CI: [1.16-7.37]), perceived information quality (AOR = 3.54, 95% CI: [1.55-8.11]), perceived service quality (AOR = 3.15, 95% CI: [1.58-6.28]), perceived system quality (AOR = 3.05, 95% CI: [1.32-7.05]), EMR training (AOR = 4.00, 95% CI: [1.76-9.03]), computer access (AOR = 3.17, 95% CI: [1.19-8.46]), and HMIS training (AOR = 2.05, 95% CI: [1.22-6.71]). In this study, health professionals' EMR satisfaction was moderate. The result showed that EMR training, computer literacy, computer access, perceived system quality, information quality, service quality, and HMIS training were associated with user satisfaction. Improving computer-related training, system quality, information quality, and service quality is an important intervention to improve the healthcare professional's satisfaction towards using electronic health record systems in Ethiopia.

Abstract P6-05-52: Addressing Healthcare Gaps and Disparities in Electronic Medical Record Messages: A Quality Improvement Project Among Breast Cancer Patients

Abstract Introduction: Despite evidence that utilization of Electronic Medical Record (EMR) messaging positively impacts patients with cancer, there is little research on who uses EMR messaging and for what purpose. Methods: Sociodemographic and MyChart usage data was collected from Epic to identify patterns of EMR messaging by patients at an academic breast center. Study eligibility included breast cancer patients who completed a visit and sent at least one message to a provider during the study period (May 2021- May 2022). Chi-square and t-tests were used to describe differences between users and non-users of EMR messaging. ANOVA and chi-square were used to describe differences between race/ethnicity. Analyses were performed in R version 4.2 and p&amp;lt; 0.05 was considered statistically significant. Results: A total of 4069 patients who had MyChart account activated were included in the analysis sample. Of those, 3575 (87.9%) were messaging users and 494 (12.1%) were non-users. The mean age of users was significantly lower compared to the non-users (57.7 vs 61.2, p&amp;lt; .001). There were statistically significant racial/ethnic differences (p&amp;lt; 0.001) by user status with 83.9% and 9.5% of users being non-Hispanic White (NHW) and non-Hispanic Black (NHB) respectively. Among non-users 69.6% were NHW and 21.1% were NHB. There were also significant differences in preferred language (p&amp;lt; 0.001) and payor (p&amp;lt; 0.001) by user status. 99.2% of users were English speaking and 96.8% of non-users were non-English speaking. 54% and 38%, and 6.5% of users had Managed care, Medicare, and Medicaid respectively as their payor. Whereas 36.9%, 51%, and 10.5% of non-users had Managed care, Medicare, and Medicaid respectively. Lastly, there were statistically significant racial/ethnic differences in the types of messages sent among EMR users. Conclusions: There are significant differences in race/ethnicity among EMR users and non-users, and racial/ethnic differences in the types of messages sent among EMR messaging users. We believe that these differences may be in part due to disparities in access or comfort in using EMR. Future directions include conducting interviews with minority patients who are users and non-users of EMR messaging to identify barriers and gaps in use. Table 1. Patient Characteristics. Characteristics of users and non-users of EMR messaging. Chi-square and T-test for significance were performed to assess the difference between groups. P&amp;lt; .05 was considered significant. Table 2. Message Type by Race/Ethnicity. Types of message sent by race/ethnicity. ANOVA and chi-square were used to describe differences between race/ethnicity and type of message sent. P&amp;lt; .05 was considered significant. Citation Format: Meghan Conroy, Miracle Powell, Sneha Nagavally, Aprill Dawson, Anna Beckius, Heun Min, Maressa Sweeney, Elizabeth Weil, Angela Hallbach, Lubna N. Chaudhary, Yee Chung Cheng, Jutta Deiinger, John Burfeind, Janet Retseck, Tamiah Wright, John Charlson, Sailaja Kamaraju. Addressing Healthcare Gaps and Disparities in Electronic Medical Record Messages: A Quality Improvement Project Among Breast Cancer Patients [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-52.

Utilizing remote access for electronic medical records reduces overall electronic medical record time for vascular surgery residents

ObjectiveSurvey data suggests that surgical residents spend 20% to 30% of training time using the electronic medical record (EMR), raising concerns about burnout and insufficient operative experience. We characterize trainee EMR activity in the vascular surgery service of a quaternary care center to identify modifiable factors associated with high EMR use. MethodsResident activity while on the vascular surgery service was queried from the EMR. Weekends and holidays were excluded to focus on typical staffing periods. Variables including daily time spent, post-graduate year (PGY), remote access via mobile device or personal laptop, and patient census including operative caseload were extracted. Univariate analysis was performed with t tests and χ2 tests where appropriate. We then fit a linear mixed-effects model with normalized daily EMR time as the outcome variable, random slopes for resident and patient census, and fixed effects of PGY level, academic year, and fractional time spent using remote access. ResultsEMR activity for 53 residents from July 2015 to June 2019 was included. The mean daily EMR usage was 1.6 hours, ranging from 3.6 hours per day in PGY1 residents to 1.1 hours in PGY4 to 5 residents. Across all PGYs, the most time-consuming EMR activities were chart review (43.0%-46.6%) and notes review (22.4%-27.0%). In the linear mixed-effects model, increased patient census was associated with increased daily EMR usage (Coefficient = 0.61, P-value < .001). Resident seniority (Coefficient = −1.2, P-value < .001) and increased remote access (Coefficient = −0.44, P-value < .001) were associated with reduced daily EMR usage. Over the study period, total EMR usage decreased significantly from the 2015/2016 academic year to the 2018/2019 academic year (mean difference, 2.4 hours vs 1.78; P-value < .001). ConclusionsIn an audit of EMR activity logs on a vascular surgery service, mean EMR time was 1.6 hours a day, which is lower than survey estimates. Resident seniority and remote access utilization were associated with reduced time spent on the EMR, independent of patient census. Although increasing EMR accessibility via mobile devices and personal computers have been hypothesized to contribute to poor work-life balance, our study suggests a possible time-saving effect by enabling expedient access for data review, which constitutes the majority of resident EMR activity. Further research in other institutions and specialties is needed for external validation and exploring implications for resident wellness initiatives.

Electronic Medical Record System Use and Determinants in Ethiopia: Systematic Review and Meta-Analysis

The strategic plan of the Ethiopian Ministry of Health recommends an electronic medical record (EMR) system to enhance health care delivery and streamline data systems. However, only a few exhaustive systematic reviews and meta-analyses have been conducted on the degree of EMR use in Ethiopia and the factors influencing success. This will emphasize the factors that make EMR effective and increase awareness of its widespread use among future implementers in Ethiopia. This study aims to determine the pooled estimate of EMR use and success determinants among health professionals in Ethiopia. We developed a protocol and searched PubMed, Web of Sciences, African Journals OnLine, Embase, MEDLINE, and Scopus to identify relevant studies. To assess the quality of each included study, we used the Joanna Briggs Institute quality assessment tool using 9 criteria. The applicable data were extracted using Microsoft Excel 2019, and the data were then analyzed using Stata software (version 11; StataCorp). The presence of total heterogeneity across included studies was calculated using the index of heterogeneity I2 statistics. The pooled size of EMR use was estimated using a random effect model with a 95% CI. After reviewing 11,026 research papers, 5 papers with a combined total of 2439 health workers were included in the evaluation and meta-analysis. The pooled estimate of EMR usage in Ethiopia was 51.85% (95% CI 37.14%-66.55%). The subgroup study found that the northern Ethiopian region had the greatest EMR utilization rate (58.75%) and that higher (54.99%) utilization was also seen in publications published after 2016. Age groups <30 years, access to an EMR manual, EMR-related training, and managerial support were identified factors associated with EMR use among health workers. The use of EMR systems in Ethiopia is relatively low. Belonging to a young age group, accessing an EMR manual, receiving EMR-related training, and managerial support were identified as factors associated with EMR use among health workers. As a result, to increase the use of EMRs by health care providers, it is essential to provide management support and an EMR training program and make the EMR manual accessible to health professionals.

Implementation of a Work-Related Asthma Screening Questionnaire in Clinical Settings: Multimethods Study.

BackgroundA work-related asthma (WRA) screening questionnaire is currently being validated for implementation in clinical settings. To minimize barriers to integrating tools into clinical practice, a discussion of strategies for the implementation of the questionnaire has begun.ObjectiveThis study aimed to understand the benefits, feasibility, barriers, and limitations of implementing the Work-related Asthma Screening Questionnaire–Long version (WRASQ[L]) and asthma e-tools in clinical settings and propose dissemination and implementation strategies for the WRASQ(L).MethodsThis study was conducted in Kingston, Ontario, Canada, from September 2019 to August 2021. A workshop and 2 questionnaires were used to understand the benefits of and barriers to implementing the questionnaire in clinical settings. An expert advisory committee was established to develop the implementation and dissemination strategies. Workshops were semistructured and used thematic qualitative analysis to identify themes that provided an understanding of the benefits and limitations of and barriers to using the WRASQ(L), and e-tools in general, in clinical settings. Workshop participants included patients and health care providers, including physicians, nurses, and asthma educators, who were implementation specialists and expert electronic medical record users. A questionnaire focusing on providers’ knowledge and awareness of WRA and another focusing on WRASQ(L) feedback was administered at the workshops. Advisory committee members from relevant stakeholders met 3 times to strategize implementation opportunities.ResultsA total of 6 themes were identified in the workshop: involving and addressing patient needs, novel data collection, knowledge translation, time considerations, functional and practical barriers, and human limitations. Questionnaire responses yielded positive feedback on the utility of the WRASQ(L) in clinical settings. All participants agreed that it is an easy way of collecting information on occupational and exposure history and could prompt a discussion between the health care provider and patient on how the workplace and exposures could affect one’s asthma, increase awareness of WRA in patients and providers, and increase awareness of exposures in the workplace. Implementation and dissemination strategies were generated with input from the advisory committee.ConclusionsStakeholders and workshop participants consider the WRASQ(L) to be a useful tool that satisfies many provider needs in their clinical settings. Once validated, dissemination strategies will include developing educational materials that include the WRASQ(L), linking the questionnaire to stakeholder websites or e-toolkits, translation into other languages, leveraging health care and research networks, conference presentations, and peer-reviewed publications. Implementation strategies will include integration into electronic medical records; designing multifaceted interventions; and targeting nontraditional settings such as workplaces, pharmacies, and research settings. The WRASQ(L) addresses many benefits of and barriers to implementation, as identified in the workshop themes. These themes will guide future implementation and dissemination strategies, noting that human limitations identified in providers and patients will need to be overcome for successful implementation.

The Effect of Transactional Leadership Style of the Head of Emergency Room, Teamwork and Work Environment on The Compliance Level of Health Worker in the Use of Electronic Medical Record with Motivation as an Intervening Variable at Tarakan Hospital

Document management using a computer-based system in the health sector which is becoming a global trend is the Electronic Medical Record (EMR). EMR is a sub-system of health information that has begun to be widely applied in Indonesia. Based on the results of data from the Tarakan Hospital, only 24% of EMR usage was found in July 2021 in the Emergency Room. This study aims to analyze the effect of the transactional leadership style of the head of the emergency department, teamwork and work environment on the level of compliance of health workers in implementing EMR with motivation as an intervening variable in Tarakan Hospital. This study is a cross-sectional study with a quantitative causality approach. By using purposive sampling technique, as many as 100 health workers were sampled in this study. Statistical tests were performed using frequency distribution and path analysis. Most (60%) of the subjects were &gt;30 years old, most (59%) had an undergraduate education level, and most (62%) had worked &gt;5 years. The results of the analysis in this study indicate that the transactional leadership style of the ER head, teamwork, work environment, affects the level of compliance of health workers in implementing EMR with motivation as an intervening variable in the ER at Tarakan Hospital. Therefore, support is needed in the implementation of EMR with the right standard operating procedures so that it can be carried out and developed to the maximum.

Rekam Medis Elektronik sebagai Pendukung Manajemen Pelayanan Pasien di RS Universitas Gadjah Mada

Electronic Medical Records (EMR) is a digital repository of administrative and medical data to support integrated health services. EMR can be used to support case management activities such as identification, care coordination, patient progress monitoring, and provide cost-effective interventions. One of main factor in information system implementation is users. Based on users’ perceptions, recommendations can be made. It’s used to maximize the adoption and development of EMR. The purpose of this study to explore the users’ perceived benefits of EMR implementation to support case management. This research is a qualitative research with a case study design. Informants were EMR users, namely doctors, nurse, pharmacist, medical record officer, and laboratory assistant. They were selected through purposive sampling technique. We conducted face-to-face semi-structured interviews and observation. This research used an interview guide with open-ended questions and an observation guide. Results showed benefits of EMR were support patient safety, reduce duplicate examinations, continuity of care, patient care efficiency, and collaboration among health professionals. It is suggested to develop a patient reminder feature and periodic staff training.

A Micro-analysis Approach in Understanding Electronic Medical Record Usage in Rural Communities: Comparison of Frequency of Use on Performance Before and During the COVID-19 Pandemic

In strengthening eHealth in the Philippines to support the universal health care (UHC) law, the scaling up and full adoption of electronic medical record (EMR) systems was strategically scheduled and supposedly completed in 2020. The Covid-19 pandemic, however, delayed these strengthening efforts. We wanted to assess the status of EMR adoption in primary clinics of rural health units (RHUs) and understand the frequency of use, particularly during the pandemic. Through analyses of EMR usage logs from selected RHUs in 2020, we estimated frequency of EMR usage based on duration of use and tested if this was influenced by the performing RHU and pandemic event. We also determined the most frequent EMR activities through process maps and tested if there were differences in the conduct of these activities before and during the pandemic. Results showed that EMR use during work hours was significantly dependent on the performing RHU (p<0.001). High-performing RHUs used EMRs more than 3 hours/day while low-performing RHUs used the systems for less. The pandemic either significantly decreased or increased EMR use during work hours by around 5 hours/day in some RHUs (p<0.01). Process maps revealed that there were additional activities performed by RHUs during the pandemic. Except for Update Patient Profile and Add Patient EMR features, significant differences (p<0.01) were observed in accessing frequently used features before and during the pandemic. The results suggest some uneven level of utilization of EMRs at the primary care level which can impact readiness to support full implementation of the UHC law. The study shows the potential of using a more granular approach in studying adoption to help improve the quality of EMR use and contribute to improving health service delivery and financing.

A simple electronic medical record system designed for research

With the extensive deployment of electronic medical record (EMR) systems, EMR usability remains a significant source of frustration to clinicians. There is a significant research need for software that emulates EMR systems and enables investigators to conduct laboratory-based human–computer interaction studies. We developed an open-source software package that implements the display functions of an EMR system. The user interface emphasizes the temporal display of vital signs, medication administrations, and laboratory test results. It is well suited to support research about clinician information-seeking behaviors and adaptive user interfaces in terms of measures that include task accuracy, time to completion, and cognitive load. The Simple EMR System is freely available to the research community and is on GitHub.

Usability assessment of an open-source simulated electronic medical record in pharmacy education

Background and PurposeThe growth of electronic medical records (EMRs) has been a critical component of evolving pharmacy practice, catalyzed by foundational initiatives such as the HITECH Act in 2009. The objective of this study was to evaluate the usability and student perceptions of a novel, open-source, educational EMR (EdEMR) for integration in the PharmD program at the University of British Columbia (UBC). Educational Activity and SettingParticipants were PharmD students at UBC and had to complete a series of survey questions and EdEMR tasks including a Systems Usability Scale (SUS) evaluation. Task completion time, mouse clicks, SUS score, and 5-point Likert scale rankings of student opinions on the use of the EdEMR were collected. FindingsSeven students successfully completed the study. Participants self-ranked themselves as novice EMR users who used EMRs a few times a week. The mean time to complete the tasks was 6 min, 42 seconds and was approximately double that of benchmark times (mean benchmark = 2 min, 20 seconds). The EdEMR scored within the upper quartile of SUS scores (mean = 83), indicating good usability. Participants identified that the EMR would most optimally be used for distance learning and case-based learning. SummaryThe EdEMR showed good usability as demonstrated by the successfully completed tasks and SUS score. Participants were receptive to the EdEMR's application as an online learning tool and for case-based learning. The EdEMR is an enticing, open-source tool currently available to all pharmacy programs and could further support online and remote teaching.

Electronic medical records and primary care quality: Evidence from Manitoba

Improvements in quality of care through supporting decision-making processes and increased efficiency have prompted widespread implementation of electronic medical records (EMRs) in Canada. Using a set of indicators of preventive care, chronic disease management, and hospitalizations due to ambulatory care sensitive conditions (ACSC), this study measures the effect of EMR adoption on quality of primary care measures. Population-based data for the Canadian province of Manitoba are used in a difference-in-differences approach with patient- and time-fixed effects. Evidence of changes in the selected quality-of-care indicators is weak, with preventive care, management of asthma, and hospitalizations showing no significant change due to EMR adoption. A statistically significant increase in the quality of diabetes care was found for EMR users, changes being larger for late EMR adopters which is possibly explained by a network effect. This research demonstrates that measuring whether EMRs prompt changes in the quality of care confronts serious challenges. The rapid evolution and gradual adoption of EMR technology, the inevitable learning/acceptance process by individual health practitioners, and its potential reflection on different patient populations create unmeasurable variables that confound EMRs' impact. This study also underscores the importance of data development to support the economic value of EMRs.