A hospital-wide transition from paper to digital problem-oriented clinical notesA descriptive history and cross-sectional survey of use, usability, and satisfaction
11 August 2016
04 March 2017
21 December 2017 (online)
Objectives: To evaluate the use, usability, and physician satisfaction of a locally developed problem-oriented clinical notes application that replaced paper-based records in a large Dutch university medical center.
Methods: Using a clinical notes database and an application event log file and a cross-sectional survey of usability, authors retrospectively analyzed system usage for medical specialties, users, and patients over 4 years. A standardized questionnaire measured usability. Authors analyzed the effects of sex, age, professional experience, training hours, and medical specialty on user satisfaction via univariate analysis of variance. Authors also examined the correlation between user satisfaction in relation to users’ intensity of use of the application.
Results: In total 1,793 physicians used the application to record progress notes for 219,755 patients. The overall satisfaction score was 3.2 on a scale from 1 (highly dissatisfied) to 5(highly satisfied). A statistically significant difference occurred in satisfaction by medical specialty, but no statistically significant differences in satisfaction took place by sex, age, professional experience, or training hours. Intensity of system use did not correlate with physician satisfaction.
Conclusions: By two years after the start of the implementation, all medical specialties utilized the clinical notes application. User satisfaction was neutral (3.2 on a 1–5 scale). Authors believe that the significant factors facilitating this transition mirrored success factors reported by other groups: a generic, consistent, and transparent design of the application; intensive collaboration; continuous monitoring; and an incremental rollout.
Citation: Cillessen FHJM, de Vries Robbé PF, Biermans MCJ. A hospital-wide transition from paper to digital problem-oriented clinical note. Appl Clin Inform 2017; 8: 502–514 https://doi.org/10.4338/ACI-2016-08-RA-0137
KeywordsElectronic health records and systems - problem-oriented medical records - evaluation - satisfaction - physician
Human Subject Research Approval
The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects, and was reviewed by the privacy officer as a representative of the board of directors of the Radboud University Medical Center, Nijmegen, the Netherlands.
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