A Two-Year Longitudinal Assessment of Ophthalmologists’ Perceptions after Implementing an Electronic Health Record SystemFunding This work was supported by the Heed Foundation (Joshua R. Ehrlich, MD, MPH).
26. Mai 2016
accepted: 17. August 2016
18. Dezember 2017 (online)
Objectives To understand the attitudes and perceptions of ophthalmologists toward an electronic health record (EHR) system, before and after its clinical implementation.
Methods Ophthalmologists at a single large academic ophthalmology department were surveyed longitudinally before and after implementation of a new EHR system. The survey measured ophthalmologists’ attitudes toward implementation of a new EHR. Questions focused on satisfaction, efficiency, and documentation. All attending physicians (between 56 and 61 at various time points) in the University of Michigan Department of Ophthalmology and Visual Sciences were surveyed. We plotted positive responses to survey questions and assessed whether perceptions followed a J-curve with an initial decrease followed by an increase surpassing pre-implementation levels.
Results Survey responses were received from 32 (52%) ophthalmologists pre-implementation, and 28 (46%) at 3 months, 35 (57%) at 7 months, 40 (71%) at 13 months and 39 (67%) at 24 months post-implementation. After EHR implementation respondents were more likely to express concerns about their ability to create high-quality documentation (p<0.01) and the impact of an electronic health record on meaningful patient interaction (p<0.01). Physicians did not report a significant change in the amount of time spent documenting outside of regular clinical work hours (p=0.54) or on their clinic efficiency and workflow (p=0.97). There was no significant change in overall job satisfaction during the study period (p=0.69). We did not observe a J-curve for any of the survey responses analyzed.
Conclusions As ophthalmology practices continue to transition to EHRs, adapting them to their specific culture and needs is important to maintain efficiency and user satisfaction. This study identifies areas of concern to ophthalmologists that may be addressed through education of physicians and customization of software as other practices move forward with EHR implementation.
Citation: Ehrlich JR, Michelotti M, Blachley TS, Zheng K, Couper MP, Greenberg GM, Kileny S, Branford GL, Hanauer DA, Weizer JS. A two-year longitudinal assessment of ophthalmologists’ perceptions after implementing an electronic health record system.
KeywordsOphthalmology - implementation and deployment - electronic health records and systems - testing and evaluation - clinical documentation and communications
- 1 Hsiao C-J, Hing E. Use and characteristics of electronic health record systems among office-based physician practices: United States, 2001-2012. NCHS Data Brief 2012; 111: 1-8.
- 2 Blumenthal D, Tavenner M. The “Meaningful Use” Regulation for Electronic Health Records. N Engl J Med 2010; 363 (06) 501-504.
- 3 Buntin MB, Jain SH, Blumenthal D. Health Information Technology: Laying The Infrastructure For National Health Reform Health Aff (Millwood). 2010; 29 (06) 1214-1219.
- 4 Blumenthal D. Launching HITECH. N Engl J Med 2010; 362 (05) 382-385.
- 5 Meaningful Use Criteria and How to Attain Meaningful Use of EHRs. [cited 2015 Sep 16]. Available from: http://www.healthit.gov/providers-professionals/how-attain-meaningful-use.
- 6 Summary of AAO Membership Survey on Electronic Health Records. [cited 2015 Sep 17]. Available from: http://www.aao.org/asset.axd?id=8177bc13-7cdf-4862-8193-d3b6971d9c81&t=634962799117670000.
- 7 Boland MV, Chiang MF, Lim MC, Wedemeyer L, Epley KD, McCannel CA, Silverstone DE, Lum F. American Academy of Ophthalmology Medical Information Technology Committee. Adoption of electronic health records and preparations for demonstrating meaningful use: an American Academy of Ophthalmology survey. Ophthalmology 2013; 120 (08) 1702-1710.
- 8 Office-based Physician Electronic Health Record Adoption: 2004-2014. [cited 2016 Jul 21]. Available from: http://dashboard.healthit.gov/quickstats/pages/physician-ehr-adoption-trends.php.
- 9 Chiang MF, Boland MV, Brewer A, Epley KD, Horton MB, Lim MC, McCannel CA, Patel SJ, Silverstone DE, Wedemeyer L, Lum F. American Academy of Ophthalmology Medical Information Technology Committee. Special requirements for electronic health record systems in ophthalmology. Ophthalmology 2011; 118 (08) 1681-1687.
- 10 Sanders DS, Read-Brown S, Tu DC, Lambert WE, Choi D, Almario BM, Yackel TR, Brown AS, Chiang MF. Impact of an electronic health record operating room management system in ophthalmology on documentation time, surgical volume, and staffing. JAMA Ophthalmol 2014; 132 (05) 586-592.
- 11 Chan P, Thyparampil PJ, Chiang MF. Accuracy and speed of electronic health record versus paper-based ophthalmic documentation strategies. Am J Ophthalmol 2013; 156 (01) 165-172 e2..
- 12 Chiang MF, Read-Brown S, Tu DC, Choi D, Sanders DS, Hwang TS, Bailey S, Karr DJ, Cottle E, Morrison JC, Wilson DJ, Yackel TR. Evaluation of electronic health record implementation in ophthalmology at an academic medical center (an American Ophthalmological Society thesis). Trans Am Ophthalmol Soc 2013; 111: 70-92.
- 13 Sanders DS, Lattin DJ, Read-Brown S, Tu DC, Wilson DJ, Hwang TS, Morrison JC, Yackel TR, Chiang MF. Electronic health record systems in ophthalmology: impact on clinical documentation. Ophthalmology 2013; 120 (09) 1745-1755.
- 14 Lim MC, Patel RP, Lee VS, Weeks PD, Barber MK, Watnik MR. The long-term financial and clinical impact of an electronic health record on an academic ophthalmology practice. J Ophthalmol 2015; Article ID 329819. doi:10.1155/2015/329819.
- 15 Singh RP, Bedi R, Li A, Kulkarni S, Rodstrom T, Altus G, Martin DF. The Practice Impact of Electronic Health Record System Implementation Within a Large Multispecialty Ophthalmic Practice. JAMA Ophthalmol 2015; 133 (06) 668-674.
- 16 Redd TK, Read-Brown S, Choi D, Yackel TR, Tu DC, Chiang MF. Electronic health record impact on productivity and efficiency in an academic pediatric ophthalmology practice. J AAPOS Off Publ Am Assoc Pediatr Ophthalmol Strabismus Am Assoc Pediatr Ophthalmol Strabismus 2014; 18 (06) 584-589.
- 17 Pandit RR, Boland MV. The impact of an electronic health record transition on a glaucoma subspecialty practice. Ophthalmology 2013; 120 (04) 753-760.
- 18 Chiang MF, Boland MV, Margolis JW, Lum F, Abramoff MD, Hildebrand PL. American Academy of Ophthalmology Medical Information Technology Committee. Adoption and perceptions of electronic health record systems by ophthalmologists: an American Academy of Ophthalmology survey. Ophthalmology 2008; 115 (09) 1591-1597.
- 19 Elrod PD, Tippett DD. The “death valley” of change. J Organ Change Manag 2002; 15 (03) 273-291.
- 20 Hanauer DA, Branford GL, Greenberg G, Kileny S, Couper MP, Zheng K, Choi SW. Two-year longitudinal assessment of physicians’ perceptions after replacement of a longstanding homegrown electronic health record: does a J-curve of satisfaction really exist?. J Am Med Inform Assoc JAMIA. 2016 Jul 3;
- 21 Hanauer DA, Branford GL, Greenberg G, Kileny S, Couper MP, Zheng K, Choi SW. Two-year longitudinal assessment of physicians’ perceptions after replacement of a long-standing homegrown electronic health record: Does a J-curve of satisfaction really exist?. J Am Med Inform Assoc. in press..
- 22 McGuire MJ, Noronha G, Samal L, Yeh H-C, Crocetti S, Kravet S. Patient safety perceptions of primary care providers after implementation of an electronic medical record system. J Gen Intern Med 2013; 28 (02) 184-192.
- 23 Raglan GB, Margolis B, Paulus RA, Schulkin J. Obstetrician/gynecologists’ experiences with electronic health record systems: a narrative study. J Reprod Med 2015; 60 (3–4): 95-102.
- 24 Bishop TF, Ryan MS, McCullough CM, Shih SC, Casalino LP, Ryan AM. Do provider attitudes about electronic health records predict future electronic health record use?. Healthc Amst Neth 2015; 03 (01) 5-11.
- 25 Han YY, Carcillo JA, Venkataraman ST, Clark RSB, Watson RS, Nguyen TC, Bayir H, Orr RA. Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system. Pediatrics 2005; 116 (06) 1506-1512.
- 26 Tanner C, Gans D, White J, Nath R, Pohl J. Electronic health records and patient safety: co-occurrence of early EHR implementation with patient safety practices in primary care settings. Appl Clin Inform 2015; 06 (01) 136-147.