Download PDF
Appl Clin Inform 2018; 09(03): 725-733
DOI: 10.1055/s-0038-1668553
Research Article
Georg Thieme Verlag KG Stuttgart · New York

Emergency Physicians' Perceived Influence of EHR Use on Clinical Workflow and Performance Metrics

Courtney A. Denton
1   Center for Cognitive Studies in Medicine and Public Health, The New York Academy of Medicine, New York, New York, United States
,
Hiral C. Soni
2   Department of Biomedical Informatics, Arizona State University, Phoenix, Arizona, United States
,
Thomas G. Kannampallil
3   Department of Family Medicine, University of Illinois at Chicago, Illinois, United States
,
Anna Serrichio
1   Center for Cognitive Studies in Medicine and Public Health, The New York Academy of Medicine, New York, New York, United States
,
Jason S. Shapiro
4   Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, United States
,
Stephen J. Traub
5   Department of Emergency Medicine, Mayo Clinic, Phoenix, Arizona, United States
,
Vimla L. Patel
1   Center for Cognitive Studies in Medicine and Public Health, The New York Academy of Medicine, New York, New York, United States
2   Department of Biomedical Informatics, Arizona State University, Phoenix, Arizona, United States
› Author Affiliations Funding This research is supported by a grant (No. R01HS022670) from the Agency for Healthcare Research and Quality (AHRQ). The content is the sole responsibility of the authors and does not necessarily represent the official views of AHRQ.
Further Information

Publication History

07 April 2018

06 July 2018

Publication Date:
12 September 2018 (online)

   Permissions and Reprints

Abstract

Objective Over the last decade, electronic health records (EHRs) have shaped clinical practice. In this article, we investigated the perceived effects of EHR use on clinical workflow and meaningful use (MU) performance metrics.

Materials and Methods Semistructured interviews were conducted with 20 (n = 20) physicians at two urban emergency departments. Interview questions focused on time spent on EHR use, changes in clinical practices with EHR use, and the effect of MU performance metrics on clinical workflow. Qualitative coding using grounded theory and descriptive analyses were performed to provide descriptive insights.

Results Physicians reported that EHRs improved their clinical workflow, especially on MU-related activities including door-to-doctor time and admit decision time. EHR use also affected physicians work efficiency, quality of care provided, and overall patient safety.

Conclusion Physicians' perception of EHRs is likely to influence their practices. With negative perceptions of EHR usability problems, positive aspects of EHR use, including the influence on MU performance metrics, may be overridden.

Keywords

physician perception - EHR - meaningful use - clinical performance - emergency department

Protection of Human and Animal Subjects

The institutional review board of the hospitals (Icahn School of Medicine at Mount Sinai, Mayo Clinic) and that of The New York Academy of Medicine approved this study. Written consents were obtained from all participants.


 

  • References

  • 1 Classen DC, Bates DW. Finding the meaning in meaningful use. N Engl J Med 2011; 365 (09) 855-858
    CrossrefPubMedGoogle Scholar
  • 2 Samal L, Wright A, Healey MJ, Linder JA, Bates DW. Meaningful use and quality of care. JAMA Intern Med 2014; 174 (06) 997-998
    CrossrefPubMedGoogle Scholar
  • 3 Emani S, Ting DY, Healey M, Lipsitz SR, Karson AS, Bates DW. Physician beliefs about the meaningful use of the electronic health record: a follow-up study. Appl Clin Inform 2017; 8 (04) 1044-1053
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Holman GT, Waldren SE, Beasley JW. , et al. Meaningful use's benefits and burdens for US family physicians. J Am Med Inform Assoc 2018; 25 (06) 694-701
    CrossrefPubMedGoogle Scholar
  • 5 Furukawa MF, King J, Patel V. Physician attitudes on ease of use of EHR functionalities related to Meaningful Use. Am J Manag Care 2015; 21 (12) e684-e692
    PubMedGoogle Scholar
  • 6 Buntin MB, Burke MF, Hoaglin MC, Blumenthal D. The benefits of health information technology: a review of the recent literature shows predominantly positive results. Health Aff (Millwood) 2011; 30 (03) 464-471
    CrossrefPubMedGoogle Scholar
  • 7 Middleton B, Bloomrosen M, Dente MA. , et al; American Medical Informatics Association. Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA. J Am Med Inform Assoc 2013; 20 (e1): e2-e8
    CrossrefPubMedGoogle Scholar
  • 8 Park SY, Lee SY, Chen Y. The effects of EMR deployment on doctors' work practices: a qualitative study in the emergency department of a teaching hospital. Int J Med Inform 2012; 81 (03) 204-217
    CrossrefPubMedGoogle Scholar
  • 9 McDonald CJ, Callaghan FM, Weissman A, Goodwin RM, Mundkur M, Kuhn T. Use of internist's free time by ambulatory care Electronic Medical Record systems. JAMA Intern Med 2014; 174 (11) 1860-1863
    CrossrefPubMedGoogle Scholar
  • 10 Sinsky C, Colligan L, Li L. , et al. Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties. Ann Intern Med 2016; 165 (11) 753-760
    CrossrefPubMedGoogle Scholar
  • 11 Carayon P, Wetterneck TB, Alyousef B. , et al. Impact of electronic health record technology on the work and workflow of physicians in the intensive care unit. Int J Med Inform 2015; 84 (08) 578-594
    CrossrefPubMedGoogle Scholar
  • 12 Clarke MA, Steege LM, Moore JL, Belden JL, Koopman RJ, Kim MS. Addressing human computer interaction issues of electronic health record in clinical encounters. In: International Conference of Design, User Experience, and Usability. Springer; 2013:381–390
    PubMedGoogle Scholar
  • 13 Chisholm CD, Weaver CS, Whenmouth L, Giles B. A task analysis of emergency physician activities in academic and community settings. Ann Emerg Med 2011; 58 (02) 117-122
    CrossrefPubMedGoogle Scholar
  • 14 Handel DA, Hackman JL. Implementing electronic health records in the emergency department. J Emerg Med 2010; 38 (02) 257-263
    CrossrefPubMedGoogle Scholar
  • 15 Perry JJ, Sutherland J, Symington C, Dorland K, Mansour M, Stiell IG. Assessment of the impact on time to complete medical record using an electronic medical record versus a paper record on emergency department patients: a study. Emerg Med J 2014; 31 (12) 980-985
    CrossrefPubMedGoogle Scholar
  • 16 Hill Jr RG, Sears LM, Melanson SW. 4000 clicks: a productivity analysis of electronic medical records in a community hospital ED. Am J Emerg Med 2013; 31 (11) 1591-1594
    CrossrefPubMedGoogle Scholar
  • 17 Mamykina L, Vawdrey DK, Stetson PD, Zheng K, Hripcsak G. Clinical documentation: composition or synthesis?. J Am Med Inform Assoc 2012; 19 (06) 1025-1031
    CrossrefPubMedGoogle Scholar
  • 18 Neri PM, Redden L, Poole S. , et al. Emergency medicine resident physicians' perceptions of electronic documentation and workflow: a mixed methods study. Appl Clin Inform 2015; 6 (01) 27-41
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Harris M, Wood J. Resuscitate ED metrics with split-flow design. Healthc Financ Manage 2012; 66 (12) 76-79
    PubMedGoogle Scholar
  • 20 Traub SJ, Bartley AC, Smith VD, Didehban R, Lipinski CA, Saghafian S. Physician in Triage Versus Rotational Patient Assignment. J Emerg Med 2016; 50 (05) 784-790
    CrossrefPubMedGoogle Scholar
  • 21 National Quality Forum. National Voluntary Consensus Standards for Emergency Care – Phase II: Hospital-based Emergency Department (ED) Candidate Consensus Standards [PDF document]. Available at: https://www.qualityforum.org/Projects/e-g/Emergency_Care/tbEDIIcandidatemeasures.aspx . Accessed July 21, 2018
    PubMedGoogle Scholar
  • 22 Strauss A, Corbin JM. Basics of Qualitative Research: Grounded Theory Procedures and Techniques. Thousand Oaks, CA: Sage Publications, Inc.; 1990
    Google Scholar
  • 23 Asplin BR, Magid DJ, Rhodes KV, Solberg LI, Lurie N, Camargo Jr CA. A conceptual model of emergency department crowding. Ann Emerg Med 2003; 42 (02) 173-180
    CrossrefPubMedGoogle Scholar
  • 24 Marmor RA, Clay B, Millen M, Savides TJ, Longhurst CA. The impact of physician EHR usage on patient satisfaction. Appl Clin Inform 2018; 9 (01) 11-14
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Kannampallil TG, Denton CA, Shapiro JS, Patel VL. Efficiency of emergency room physicians: insights from an observational study using EHR log files. Appl Clin Inform 2018; 9 (01) 99-104
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Frisby J, Smith V, Traub S, Patel VL. Contextual Computing: a Bluetooth based approach for tracking healthcare providers in the emergency room. J Biomed Inform 2017; 65: 97-104
    CrossrefPubMedGoogle Scholar
  • 27 Soni HC, Vankipuram A, Denton CA, Shapiro JS, Traub SJ, Patel VL. Characterization of Clinical Workflow and Electronic Health Records in Emergency Medicine. Presented at AMIA 2018 Clinical Informatics Conference, May 9th, 2018, Scottsdale, AZ
    PubMedGoogle Scholar