Researchers talked to nine physicians who described their issues with EHR adoption after implementation.Most believe EHR usability issues happen at implementation. However, the majority of EHR usability problems occur after implementation when the EHR is continuously optimized, according to a study published in the BMC Medical Informatics and Decision Making.
“Implementation of the EHR is not limited to a single event in time,” wrote the researchers. “Rather, the technology changes when newer features are added, or interfaces are redesigned. These upgrades may improve functionality, but they also require physicians to adapt to changes beyond the initial implementation.”
“Users are required to continually learn how to use the newer system and then to incorporate these upgrades into their clinical workflow, often with negative work and psychological impacts,” continued the researchers. “Studies suggest that this type of continual change, such as that required by changes to the EHR, can result decreased productivity, increased stress and increased burnout.”
Using qualitative interviews with nine physicians a large academic medical center in the Midwest, the researchers confirmed that hypothesis.
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Researchers asked the physicians four main questions regarding EHR adoption after implementation: impact of changes to the EHR, dealing with changes, factors that facilitate adaptation, and impact on patient care.
First, most respondents talked about the benefits that EHRs had on their documentation.
“It probably gets there faster,” said an anonymous physician. “In the old days, I used to dictate a letter. In the 1990s I had a Dictaphone. I would see a patient, I’d dictate a letter, and then it would be transcribed. Then I had to sign it, and it was sent out. That might take a week.”
Then, the physicians talked about adapting to EHR optimization and the impact that a positive attitude has on adaption.
“Physicians identified that accepting the necessity of change in using EHRs positively influenced their ability to adapt to their use,” wrote the researchers. “Many noted that while they experienced frustrations with EHRs, they also recognized the benefits and thus felt more positive toward use.”
Researchers then asked how EHR optimization was experienced by physicians.
“What I think would be really helpful is sort of periodic updated,” said an anonymous physician. “If there’s going to be a massive change or update, or their templates are changing, approaches are changing in the EHR, if they could come to our division meeting, department meetings, probably division meeting, or even our clinics, just to give us a, ‘Hey, heads up. This is how you navigate this. A, B, or C.’”
Respondents also discussed the factors that facilitate adoption. Most respondents talked about having a positive mindset towards change, training, and recognizing the benefits of the EHR.
“Physicians expressed a desire for training that focused on the particular ways physicians use the EHR, as compared to general training provided to all users, and reported seeking out representation on EHR-related committees in order to have their perspective included,” wrote the researchers.
“In this way, training designed in collaboration with physicians to address physician-specific needs can increase perceived ease of use and help physicians adapt to using the EHR.”
Finally, they were asked about EHR impact on patient care. While some recognized the positives about its impact on patients, one physician stood out when he confirmed the notion that EHRs limit patient contact.
“Your actual evaluation of the patient might be a little shorter,” said a responding physician. “You might just sort of say, I understand from your chart that this, this, this, happened. Is that true? And they say, sure. And then you ask them a few more questions. As opposed to really talking to them for a long period of time.”
A second respondent said, “Well, you just can’t see as many patients. You can’t get as many in… You’re documenting in the computer. You’re doctoring the computer.”
Overall, the study concluded that an individual physician’s attitude toward the EHR has a major impact on EHR adoption post-optimization. Strong communication and training are crucial to successful EHR adoption and make the process of change much easier.
Source: EHR Intelligence