Impact of Electronic versus Paper-Based Recording before EHR Implementation on Health Care Professionals' Perceptions of EHR Use, Data Quality, and Data Reuse
02 December 2018
29 January 2019
20 March 2019 (online)
Background The implementation of an electronic health record (EHR) with structured and standardized recording of patient data can improve data quality and reusability. Whether and how users perceive these advantages may depend on the preimplementation situation.
Objective To determine whether the influence of implementing a structured and standardized EHR on perceived EHR use, data quality, and data reuse differed for users working with paper-based records versus a legacy EHR before implementation.
Methods We used an electronic questionnaire to measure users' perception before implementation (2014), expected change, and perceived change after implementation (2016) on three themes. We included all health care professionals in two university hospitals in the Netherlands. Before jointly implementing the same structured and standardized EHR, one hospital used paper-based records and the other a legacy EHR. We compared perceptions before and after implementation for both centers. Additionally, we compared expected benefit with perceived benefit.
Results We received 7,611 responses (4,537 before and 3,074 after implementation) of which 5,707 (75%) were from professionals reading and recording patient data. A total of 975 (13%) professionals responded to both before and after implementation questionnaires. In the formerly paper-based center staff perceived improvement in all themes after implementation. The legacy EHR center experienced deterioration of perceived EHR use and data reuse, and only one improvement in EHR use. In both centers, for half of the aspects at least 45% of responders experienced results worse than expected preimplementation.
Conclusion Our results indicate that the preimplementation recording practice impacts the perceived effect of the implementation of a structured and standardized EHR. For almost half of the respondents the new EHR did not meet their expectations. Especially legacy EHR centers need to investigate the expectations as these might be different and less clear cut than those in paper-based centers. These expectations need to be addressed appropriately to achieve a successful implementation.
Keywordselectronic health record - implementation - health care professionals - perceptions - EHR use - data quality - data reuse
Protection of Human and Animal Subjects
The study design for both participating centers was submitted to the ethics committee of the Academic Medical Center, Amsterdam, and was exempt from review (W14_088 # 14.17.0114 and W15_339 # 15.0394).
- 1 Vuokko R, Mäkelä-Bengs P, Hyppönen H, Lindqvist M, Doupi P. Impacts of structuring the electronic health record: results of a systematic literature review from the perspective of secondary use of patient data. Int J Med Inform 2017; 97: 293-303
- 2 Zandieh SO, Abramson EL, Pfoh ER, Yoon-Flannery K, Edwards A, Kaushal R. Transitioning between ambulatory EHRs: a study of practitioners' perspectives. J Am Med Inform Assoc 2012; 19 (03) 401-406
- 3 Ehrlich JR, Michelotti M, Blachley TS. , et al. A two-year longitudinal assessment of ophthalmologists' perceptions after implementing an electronic health record system. Appl Clin Inform 2016; 7 (04) 930-945
- 4 Krousel-Wood M, McCoy AB, Ahia C. , et al. Implementing electronic health records (EHRs): health care provider perceptions before and after transition from a local basic EHR to a commercial comprehensive EHR. J Am Med Inform Assoc 2018; 25 (06) 618-626
- 5 Asan O, , D Smith P, Montague E. More screen time, less face time - implications for EHR design. J Eval Clin Pract 2014; 20 (06) 896-901
- 6 Ludwick DA, Doucette J. Adopting electronic medical records in primary care: lessons learned from health information systems implementation experience in seven countries. Int J Med Inform 2009; 78 (01) 22-31
- 7 McGeorge NM, Hegde S, Guarrera TK. , et al. Studying the impact of interoperable electronic health records on workflow in ambulatory care. Int J Ind Ergon 2015; 49: 144-155
- 8 Gagnon M-P, Desmartis M, Labrecque M. , et al. Systematic review of factors influencing the adoption of information and communication technologies by healthcare professionals. J Med Syst 2012; 36 (01) 241-277
- 9 Joukes E, Cornet R, de Bruijne MC, de Keizer NF, Abu-Hanna A. Development and validation of a model for the adoption of structured and standardised data recording among healthcare professionals. BMC Med Inform Decis Mak 2018; 18 (01) 54
- 10 Zandieh SO, Yoon-Flannery K, Kuperman GJ, Langsam DJ, Hyman D, Kaushal R. Challenges to EHR implementation in electronic- versus paper-based office practices. J Gen Intern Med 2008; 23 (06) 755-761
- 11 Cillessen FHJM, de Vries Robbé PF, Biermans MCJ. A hospital-wide transition from paper to digital problem-oriented clinical notes. A descriptive history and cross-sectional survey of use, usability, and satisfaction. Appl Clin Inform 2017; 8 (02) 502-514
- 12 Abramson EL, Patel V, Malhotra S. , et al. Physician experiences transitioning between an older versus newer electronic health record for electronic prescribing. Int J Med Inform 2012; 81 (08) 539-548
- 13 Petrona R, Chang L. Implementatie van informatiestandaarden in een EPD AMC/VUmc. Available at: https://docplayer.nl/33530390-Implementatie-van-informatiestandaarden-in-een-epd-amc-vumc.html
- 14 Wakefield DS, Halbesleben JR, Ward MM, Qiu Q, Brokel J, Crandall D. Development of a measure of clinical information systems expectations and experiences. Med Care 2007; 45 (09) 884-890
- 15 Bossen C, Jensen LG, Udsen FW. Evaluation of a comprehensive EHR based on the DeLone and McLean model for IS success: approach, results, and success factors. Int J Med Inform 2013; 82 (10) 940-953
- 16 Kirkendall ES, Goldenhar LM, Simon JL, Wheeler DS, Andrew Spooner S. Transitioning from a computerized provider order entry and paper documentation system to an electronic health record: expectations and experiences of hospital staff. Int J Med Inform 2013; 82 (11) 1037-1045
- 17 R Core Team. R: A Language and Environment for Statistical Computing. 2017. Available at: https://www.r-project.org/ . Accessed February 11, 2019
- 18 Melas CD, Zampetakis LA, Dimopoulou A, Moustakis V. Modeling the acceptance of clinical information systems among hospital medical staff: an extended TAM model. J Biomed Inform 2011; 44 (04) 553-564
- 19 Risko N, Anderson D, Golden B. , et al. The impact of electronic health record implementation on emergency physician efficiency and patient throughput. Healthc (Amst) 2014; 2 (03) 201-204
- 20 Joukes E, Abu-Hanna A, Cornet R, de Keizer NF. Time spent on dedicated patient care and documentation tasks before and after the introduction of a structured and standardized electronic health record. Appl Clin Inform 2018; 9 (01) 46-53
- 21 Ratwani R, Fairbanks T, Savage E. , et al. Mind the gap. A systematic review to identify usability and safety challenges and practices during electronic health record implementation. Appl Clin Inform 2016; 7 (04) 1069-1087