A Two-Year Longitudinal Assessment of Ophthalmologists’ Perceptions after Implementing an Electronic Health Record System

Abstract

SummaryObjectives: 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.

Promoting Quality Face-to-Face Communication during Ophthalmology Encounters in the Electronic Health Record Era

“…1,4,7,[12][13][14][15][16] One longitudinal study conducted in an academic ophthalmology department over 2 years before and after EHR implementation demonstrated that ophthalmologists were significantly more likely to express concern about the impact of an EHR on meaningful patient interaction after implementation. 17 One strategy to address these issues has focused on redesigning EHRs, with multiple studies examining how to improve EHR usability, optimize user interfaces, and reduce click burden. 8,[18][19][20][21][22][23] However, executing EHR design changes can be constrained by limitations imposed by institutional infrastructure or by EHR vendors.…”

Nurses’ Experience With Health Information Technology: Longitudinal Qualitative Study

“…Physicians reported that the EHR created additional work and their satisfaction dropped [ 9 ]. In a similarly-designed study, ophthalmologists did not report a significant change in overall job satisfaction over time (3, 7, 13, and 24 months post-EHR implementation), but they expressed concern about the EHR’s effect on interactions with patients and their ability to create quality documentation [ 10 ]. In primary care, even two years after EHR implementation, the EHR learning curve and computer knowledge remained challenging for interprofessional staff [ 11 ].…”

Die elektronische Patientenakte im Krankenhausinformationssystem

“…In der Augenheilkunde ist der Bedarf einer geordneten, übersichtlichen und vollständigen Darstellung der unterschiedlichsten Untersuchungen und Befunde besonders groß [4]. Die hohe Zahl an Patientenkontakten sowie die Häufung chronischer und komplexer Krankheitsverläufe machen eine schnelle Orientierung in der Patientenakte unverzichtbar.…”