Electronic Medical Record Users Research Articles

Design of Electronic Medical Record User Interfaces: A Matrix‐Based Method for Improving Usability

This study examines a new approach of using the Design Structure Matrix (DSM) modeling technique to improve the design of Electronic Medical Record (EMR) user interfaces. The usability of an EMR medication dosage calculator used for placing orders in an academic hospital setting was investigated. The proposed method captures and analyzes the interactions between user interface elements of the EMR system and groups elements based on information exchange, spatial adjacency, and similarity to improve screen density and time-on-task. Medication dose adjustment task time was recorded for the existing and new designs using a cognitive simulation model that predicts user performance. We estimate that the design improvement could reduce time-on-task by saving an average of 21 hours of hospital physicians' time over the course of a month. The study suggests that the application of DSM can improve the usability of an EMR user interface.

Users′ acceptance and attitude in regarding electronic medical record at central polyclinic of oil industry in Isfahan, Iran

Introduction:Simultaneous with the rapid changes in the technology and information systems, hospitals interest in using them. One of the most common systems in hospitals is electronic medical record (EMR) whose one of uses is providing better health care quality via health information technology. Prior to its use, attempts should be put to identifying factors affecting the acceptance, attitude and utilizing of this technology. The current article aimed to study the effective factors of EMR acceptance by technology acceptance model (TAM) at central polyclinic of Oil Industry in Isfahan.Materials and Methods:This was a practical, descriptive and regression study. The population research were all EMR users at polyclinic of Oil Industry in 2012 and its sampling was simple random with 62 users. The tool of data collection was a research-made questionnaire based on TAM. The validity of questionnaire has been assigned through the strategy of content validity and health information technology experts’ views and its reliability by test-retest.Findings:The system users have positive attitude toward using EMR (56.6%). Also, users are not very satisfied with effective external (38.14%) and behavioral factors (47.8%) upon using the system. Perceived ease-of-use (PEU) and perceived usefulness (PU) were at a good level.Conclusion:Lack of relative satisfaction with using of EMR derives from factors such as appearance, screen, data and information quality and terminology. In this study, it is suggested to improve the system and the efficiency of the users through software’ external factors development. So that PEU and users’ attitude to be changed and moved in positive manner.

A Study on the Satisfaction of Nurses with Electronic Medical Records in General Hospitals

A hospital’s adoption of Electronic Medical Records (EMRs) is a prerequisite to fully adopt Electronic Health Records (EHRs). The goal of a fully integrated EHR is to improve patient care quality and safety. Satisfaction of users during and after implementation of EMRs system can help successful implementation and on-going effectiveness of EMRs system. Nurses from two hospitals in Iksan City in Jeonbuk Province were surveyed to identify demographics and strategies to mitigate barriers to EMR implementation. Both hospitals had implemented EMRs system over two years ago. 204 clinical nurses provided responses to the survey questionnaire. Four different categories of satisfaction were analyzed against the demographic variables. This was also to provide data to the hospitals that plan to EMR implementation near future.BR Neither hospital had previously obtained any satisfaction data from employees regarding their experience with the EMR implementation or usage. However, several trends were identified.BR First, overall satisfaction with EMRs was highest for nurses with less than four year employment at those hospitals. Nurses with greater than 20 years of service had the least EMR and job satisfaction of those surveyed. All were statistically significant.BR Second, among the different age groups analyzed, nurses in their 30’s were the most satisfied with the function and efficiency, standardization, practical use, and IT support of their EMRs. Nurses in their 20’s using EMRs had the most job satisfaction; nurses in their 40’s had the least job satisfaction since EMR implementation. Further analyses revealed the subcategory most satisfied with their EMR were college graduates with less than four years of service at their current hospitals and no prior experience with paper medical records.BR The results show it is important for hospitals to evaluate nurses’ satisfaction with EMR implementation to improve effectiveness and ensure improvements in patient care quality and safety. Hospitals may need to tailor EMR training plans and EMR support based on age, years of service, and years of use. Specifically, nurses in their 40’s and with over 20 years of service using paper records may require additional training and continued support during EMR implementation. I expect this provides data to the hospitals to implement and improve EMR system. Further research is needed to assess if mitigation strategies can improve satisfaction in certain categories and whether dissatisfaction with EMRs leads to worse outcomes. I also expect this study can be utilized to build the system as well as to improve the current system.

Differences in Electronic Medical Record Implementation and Use According to Geographical Location and Organizational Characteristics of US Federally Qualified Health Centers

Electronic medical records (EMRs) are at the forefront of the national healthcare agenda and this paper examines EMR implementation and usage based on data from the 2009 Commonwealth Fund National Survey of Federally Qualified Health Centers (FQHC). Chi-square analysis was used to examine differences in EMR implementation and usage. Logistic regression analysis was used to understand the adjusted associations between EMR implementation and usage. A significant finding of this study was that simple EMRs were implemented in more than half of FQHCs in the Northeast, Southern, and Western regions of the United States and EMRs in more than half of the FQHCs in the Southern and Western regions are not even utilized. These findings indicate simple EMR usage and full EMR implementation need improvement to meet the requirements of the American Recovery and Reinvestment Act by 2014, or face reduction in Medicare and Medicaid reimbursements.

Beyond the Focus Group: Understanding Physicians’ Barriers to Electronic Medical Records

Although electronic medical records (EMRs) have potential to improve quality of care, physician adoption remains low. Rhode Island physicians' perceptions of barriers to EMRs and the association between these barriers and physician characteristics were examined. It was hypothesized that physicians with and without EMRs would differ in the types and magnitude of barriers identified. Data were drawn from the Rhode Island Department of Health's mandatory 2009 Physician Health Information Technology (HIT) survey of physicians licensed and in active practice in Rhode Island or an adjacent state. Some 1,888 (58.1% of the target population of 3,248 physicians) responded. Respondents, who were invited to provide open-ended comments, were asked to consider 11 issues as barriers to EMR use: Access to technical support, lack of computer skills, availability of a computer in the appropriate location, impact of a computer on doctor-patient interaction, lack of interoperability, privacy or security concerns, start-up financial costs, ongoing financial costs, technic limitations of systems, training and productivity impact, and lack of uniform industry standards. Respondents with EMRs consistently perceived significantly fewer barriers than those without them (p < .0001). For example, 78.9% of physicians without EMRs viewed start-up financial costs as a major barrier versus only 45.8% of physicians with EMRs. An understanding of physicians' reluctance to use EMRs is critical for developing adoption strategies. Policies to increase EMR adoption should be tailored to different physician groups to achieve maximum effectiveness. Further research into the differences between current EMR users' and nonusers' perceptions of barriers may help elucidate how to facilitate subsequent adoption.

EMR Use Among Rural and Urban Alabama Family Medicine Physicians

The purpose of this study was to determine the adoption of electronic medical records (EMR) by rural and urban Alabama family medicine physicians. This cross-sectional study evaluated EMR use among Alabama family medicine physicians (N = 1197). Half (49.3%) of the physicians surveyed reported using EMR in their practices; however, only 16.3% reported using EMR to its fullest capacity. The majority (49.9%) were categorized as nonusers, whereas basic users comprised 12.4%, moderate users made up 19.7%, and comprehensive users were 16.7% of the total. A physician's age (P < 0.001) and years of professional practice (P = 0.002) correlate significantly with EMR use. EMR users (mean 48.48, standard deviation [SD] 9.93; mean 18.63, SD 10.58) were significantly younger and had been in practice for a shorter time than non-EMR users (mean 52.92, SD 12.01, and mean 22.44, SD 13.04, respectively). This study allowed for the exploration of the current level of EMR use, the identification of individual user characteristics, and the identification of organizational user characteristics.

Multi-disciplinary collaboration during ward rounds: Embodied aspects of electronic medical record usage

PurposeHospital medicine necessitates that practitioners from many disciplines collaborate to care for patients with complex illnesses. Much emphasis is placed on multi-disciplinary interaction during the ward round to achieve collaboration, but it can still be difficult to attain. This paper looks at how electronic medical records affect multi-disciplinary collaboration during ward rounds. MethodsWe take an embodied approach, with a specific focus on the spatial and postural patterning of bodies in space. Using F-formation system theory as an analytical starting point, we compare the non-verbal interaction systems that support multi-disciplinary interaction during usage of a paper medical record and an electronic medical record at two points after deployment. ResultsWe show that the paper medical record supports a nuanced non-verbal interaction system which is used to negotiate the ward round interaction and facilitate multi-disciplinary communication. We also illustrated how the electronic medical record initially fails to support a similar non-verbal interaction system, but with some adjustments over time, the ward round team re-establishes a functioning non-verbal interaction system and with it, multi-disciplinary communication. ConclusionsWe conclude with a discussion on the effects of electronic medical records on multi-disciplinary interaction and suggest a number of implications for their design: including, considering the social ergonomics of the device, the inclusion of paper in electronic medical records, addressing data fixation, and facilitating practitioners to make social changes to the interaction through the ability to make technical changes to the system.

Electronic Medical Records Are Not Associated With Improved Documentation in Community Primary Care Practices

The adoption of electronic medical records (EMRs) in ambulatory settings has been widely recommended. It is hoped that EMRs will improve care; however, little is known about the effect of EMR use on care quality in this setting. This study compares EMR versus paper medical record documentation of basic health history and preventive service indicators in 47 community-based practices. Differences in practice-level documentation rates between practices that did and did not use an EMR were examined using the Kruskal-Wallis nonparametric test and robust regression, adjusting for practice-level covariates. Frequency of documentation of health history and preventive service indicator items were similar in the 2 groups of practices. Although EMRs provide the capacity for more robust record keeping, the community-based practices here do not use EMRs to their full capacity. EMR usage does not guarantee more systematic record keeping and thus may not lead to improved quality in the community practice setting.

Electronic medical record use in pediatric primary care

To characterize patterns of electronic medical record (EMR) use at pediatric primary care acute visits. Direct observational study of 529 acute visits with 27 experienced pediatric clinician users. For each 20 s interval and at each stage of the visit according to the Davis Observation Code, we recorded whether the physician was communicating with the family only, using the computer while communicating, or using the computer without communication. Regression models assessed the impact of clinician, patient and visit characteristics on overall visit length, time spent interacting with families, and time spent using the computer while interacting. The mean overall visit length was 11:30 (min:sec) with 9:06 spent in the exam room. Clinicians used the EMR during 27% of exam room time and at all stages of the visit (interacting, chatting, and building rapport; history taking; formulation of the diagnosis and treatment plan; and discussing prevention) except the physical exam. Communication with the family accompanied 70% of EMR use. In regression models, computer documentation outside the exam room was associated with visits that were 11% longer (p=0.001), and female clinicians spent more time using the computer while communicating (p=0.003). The 12 study practices shared one EMR. Among pediatric clinicians with EMR experience, conversation accompanies most EMR use. Our results suggest that efforts to improve EMR usability and clinician EMR training should focus on use in the context of doctor-patient communication. Further study of the impact of documentation inside versus outside the exam room on productivity is warranted.

Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions

BackgroundThe main objective of this research is to identify, categorize, and analyze barriers perceived by physicians to the adoption of Electronic Medical Records (EMRs) in order to provide implementers with beneficial intervention options.MethodsA systematic literature review, based on research papers from 1998 to 2009, concerning barriers to the acceptance of EMRs by physicians was conducted. Four databases, "Science", "EBSCO", "PubMed" and "The Cochrane Library", were used in the literature search. Studies were included in the analysis if they reported on physicians' perceived barriers to implementing and using electronic medical records. Electronic medical records are defined as computerized medical information systems that collect, store and display patient information.ResultsThe study includes twenty-two articles that have considered barriers to EMR as perceived by physicians. Eight main categories of barriers, including a total of 31 sub-categories, were identified. These eight categories are: A) Financial, B) Technical, C) Time, D) Psychological, E) Social, F) Legal, G) Organizational, and H) Change Process. All these categories are interrelated with each other. In particular, Categories G (Organizational) and H (Change Process) seem to be mediating factors on other barriers. By adopting a change management perspective, we develop some barrier-related interventions that could overcome the identified barriers.ConclusionsDespite the positive effects of EMR usage in medical practices, the adoption rate of such systems is still low and meets resistance from physicians. This systematic review reveals that physicians may face a range of barriers when they approach EMR implementation. We conclude that the process of EMR implementation should be treated as a change project, and led by implementers or change managers, in medical practices. The quality of change management plays an important role in the success of EMR implementation. The barriers and suggested interventions highlighted in this study are intended to act as a reference for implementers of Electronic Medical Records. A careful diagnosis of the specific situation is required before relevant interventions can be determined.

Initial Observations of Electronic Medical Record Usage During CT and MRI Interpretation: Frequency of Use and Impact on Workflow

Electronic medical record (EMR) systems permit integration of contextual nonimaging EMR data into examination interpretation; however, the extra effort required to search and review these nonradiologic data are not well characterized. We assessed the gross frequency and pattern of EMR usage in the interpretation of diagnostic CT and MRI examinations. We defined nonradiologic EMR data as laboratory data, nonimaging specialty report, clinical note, and administrative data not available on PACS. For abdominal, neuroradiologic, and musculoskeletal CT and MRI, we prospectively recorded the time required for image analysis (including prior imaging studies and their reports), nonradiologic EMR use, and initial report drafting by fellows and staff in randomized sessions. We assessed EMR use as a fraction of work activity and according to technique, subspecialty, inpatient status, and radiologist experience. We observed 372 CT and MRI interpretations by 33 radiologists. For CT, radiologists used the EMR in 34% of abdominal, 57% of neuroradiologic, and 38% of musculoskeletal interpretations. For MRI, EMR was used in 73% of abdominal, 56% of neuroradiologic, and 33% of musculoskeletal interpretations. For CT, EMR usage comprised 18%, 14%, and 18% of diagnostic effort (image analysis plus EMR use) for abdominal, neuroradiologic, and musculoskeletal interpretations, respectively; for MRI, EMR usage comprised 21%, 16%, and 15% of diagnostic effort for abdominal, neuroradiologic, and musculoskeletal interpretations, respectively. Frequency of EMR use was significantly greater for neuroradiology CT and abdominal MRI (p < 0.05, Fisher's test). EMR usage was not consistently related to inpatient status for CT or radiologist experience. For CT and MRI interpretation, EMR usage is frequent and comprises a significant fraction of diagnostic effort.

Confessions of an Electronic Medical Record User

Confessions of an Electronic Medical Record User

Management of Depression in Ambulatory Care for Patients with Medical Co-Morbidities: A Study from a National Electronic Health Record (EHR) Network

Since co-morbid depression can complicate medical conditions such as cardiovascular disease and cancer, physicians may treat depression more aggressively in patients with these conditions. This study compared antidepressant medication use in persons with and without medical co-morbidities. This cross-sectional study was conducted in a national network of outpatient electronic medical record users. Participants included active adult patients with an active diagnosis of depression as of 11/30/05 (the "prevalent" population, 185,029 patients) or a new episode of depression during the one-year period 12/1/03-11/30/04 (the "incident" population, 29,768 patients). For each population, four co-morbid conditions were defined--diabetes, coronary heart disease (CHD), stroke, and cancer. Prescription of antidepressant medication was compared for persons with and without each medical condition. The most common medical condition was diabetes, with cancer being the least common (7.6% and 2.4% of the prevalent population). Overall, 69.6% of the prevalent population and 76.1% of the incident population were treated with antidepressant medications. For the prevalent population, treatment was significantly more likely for patients with diabetes (OR 1.07, 95% CI 1.03-1.11) but significantly less likely for patients with CHD (OR 0.94 95% CI 0.90-0.99), after controlling for differences in age and gender. For the incident population, treatment was significantly more likely for persons with diabetes (OR 1.14, 95% CI 1.04-1.26), CHD (OR 1.23 95% CI 1.08-1.39), and stroke (OR 1.21, 95% CI 1.04-1.42). Antidepressant medication use was somewhat higher in persons with medical co-morbidities, although these differences were small and inconsistent.

Implementation of an electronic medical record system in previously computer-naïve primary care centres: a pilot study from Cyprus

The computer-based electronic medical record (EMR) is an essential new technology in health care, contributing to high-quality patient care and efficient patient management. The majority of southern European countries, however, have not yet implemented universal EMR systems and many efforts are still ongoing. We describe the development of an EMR system and its pilot implementation and evaluation in two previously computer-naïve public primary care centres in Cyprus. One urban and one rural primary care centre along with their personnel (physicians and nurses) were selected to participate. Both qualitative and quantitative evaluation tools were used during the implementation phase. Qualitative data analysis was based on the framework approach, whereas quantitative assessment was based on a nine-item questionnaire and EMR usage parameters. Two public primary care centres participated, and a total often health professionals served as EMR system evaluators. Physicians and nurses rated EMR relatively highly, while patients were the most enthusiastic supporters for the new information system. Major implementation impediments were the physicians' perceptions that EMR usage negatively affected their workflow, physicians' legal concerns, lack of incentives, system breakdowns, software design problems, transition difficulties and lack of familiarity with electronic equipment. The importance of combining qualitative and quantitative evaluation tools is highlighted. More efforts are needed for the universal adoption and routine use of EMR in the primary care system of Cyprus as several barriers to adoption exist; however, none is insurmountable. Computerised systems could improve efficiency and quality of care in Cyprus, benefiting the entire population.

A case study on better iconographic design in electronic medical records' user interface

Background. It is a known fact that there is a conflict between what users expect and what user interface designers create in the field of medical informatics along with other fields of interface design.Objectives. The objective of the study is to suggest, from the ‘design art’ perspective, a method for improving the usability of an electronic medical record (EMR) interface. The suggestion is based on the hypothesis that the user interface of an EMR should be iconographic.Method. The proposed three-step method consists of a questionnaire survey on how hospital users perceive concepts/terms that are going to be used in the EMR user interface. Then icons associated with the terms are designed by a designer, following a guideline which is prepared according to the results of the first questionnaire. Finally the icons are asked back to the target group for proof. A case study was conducted with 64 medical staff and 30 professional designers for the first questionnaire, and with 30 medical staff for the second.Results. In the second questionnaire 7.53 icons out of 10 were matched correctly with a standard deviation of 0.98. Also, all icons except three were matched correctly in at least 83.3% of the forms.Conclusion. The proposed new method differs from the majority of previous studies which are based on user requirements by leaning on user experiments instead. The study demonstrated that the user interface of EMRs should be designed according to a guideline that results from a survey on users' experiences on metaphoric perception of the terms.

The influence of electronic medical record usage on nonverbal communication in the medical interview

This study examined nonverbal communication in relation to electronic medical record (EMR) use during the medical interview. Six physicians were videotaped during their consultations with 50 different patients at a single setting Veterans Administration Hospital. Three different office spatial designs were identified and named 'open,' 'closed' and 'blocked'. The ;open' arrangement put physicians in a position to establish better eye contact and physical orientation than did the alternative 'closed' and 'blocked' office configurations. Physicians who accessed the EMR and took 'breakpoints' (short periods of no computer use and sustained eye contact with patients) used more nonverbal cues than physicians who tended to talk with their patients while continuously working on the computer. Long pauses in conversational turn taking associated with EMR use may have positively influenced doctor-patient communication. High EMR use interviews were associated with patients asking more questions than they did in low EMR use interviews. Implications for medical education and future research are discussed.

Electronic Medical Records and Diabetes Quality of Care: Results From a Sample of Family Medicine Practices

Care of patients with diabetes requires management of complex clinical information, which may be improved by the use of an electronic medical record (EMR); however, the actual relationship between EMR usage and diabetes care quality in primary care settings is not well understood. We assessed the relationship between EMR usage and diabetes care quality in a sample of family medicine practices. We conducted cross-sectional analyses of baseline data from 50 practices participating in a practice improvement study. Between April 2003 and December 2004 chart auditors reviewed a random sample of medical records from patients with diabetes in each practice for adherence to guidelines for diabetes processes of care, treatment, and achievement of intermediate outcomes. Practice leaders provided medical record system information. We conducted multivariate analyses of the relationship between EMR usage and diabetes care adjusting for potential practice- and patient-level confounders and practice-level clustering. Diabetes care quality in all practices showed room for improvement; however, after adjustment, patient care in the 37 practices not using an EMR was more likely to meet guidelines for process (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.42-3.57) treatment (OR, 1.67; 95% CI, 1.07-2.60), and intermediate outcomes (OR, 2.68; 95% CI, 1.49-4.82) than in the 13 practices using an EMR. The use of an EMR in primary care practices is insufficient for insuring high-quality diabetes care. Efforts to expand EMR use should focus not only on improving technology but also on developing methods for implementing and integrating this technology into practice reality.

Health Information Technology and Physician-Patient Interactions: Impact of Computers on Communication During Outpatient Primary Care Visits

As a nurse practitioner student, electronic medical record (EMR) trainer, and future EMR user, I was excited to see the Hsu et al. article, “Health Information Technology and Physician–Patient Interactions: Impact of Computers on Communication During Outpatient Primary Care Visits” in the July/August issue.1 I have not seen very much research about the patient's perception …

Are electronic medical records associated with improved perceptions of the quality of medical records, working conditions, or quality of working life?

The purposes of this study were to determine if users of electronic medical records (EMRs) perceived their medical records to be of higher quality than users of paper records and to examine the relationship between EMR use and perceptions of working conditions, quality of worklife and quality of care among family physicians. To do so, a cross-sectional survey of family physicians (n = 1482) was conducted. Survey items included measurement of use of an EMR, perceptions of medical records, working conditions, job satisfaction, and quality of care. One hundred and forty-three physicians (23%) reported using EMRs. Physicians who used EMRs were significantly more satisfied with the quality of their medical records. EMR use was not related to other outcomes. While EMR users value their record systems higher than non-users value the traditional system, EMR systems do not appear to directly impact the other variables. Indirect relationships are suspected and should be tested.

Impact of an electronic medical record system on community-based primary care practices.

Although primary care physicians are increasingly interested in adopting electronic medical record (EMR) systems, few use such systems in practice. This study explores the organizational impact of an EMR system on community-based practices that have overcome the initial barriers and are experienced EMR users. Five primary care practices that are members of a national research network participated in this study. Using qualitative methods, including semistructured interviews and observations, we assessed the impact of an EMR system on the work lives of various user groups. Physicians and staff indicated that the EMR system has changed not only how they manage patient records but also how they communicate with each other, provide patient care services, and perform job responsibilities. The EMR is also perceived by its users to have an impact on practice costs. Although in most practices physicians and staff were unaware of actual expenses and cost savings associated with the EMR, those in practices that have eliminated duplicate paper-based systems believe they have realized cost savings. Several important themes emerged. The organizational context in which the system is implemented is important. Effective leadership, the presence of a system champion, availability of technical training and support, and adequate resources are essential elements to the success of the EMR.