Comparing International Experiences With Electronic Health Records Among Emergency Medicine Physicians in the United States and Norway: Semistructured Interview Study

Abstract

Background The variability in physicians’ attitudes regarding electronic health records (EHRs) is widely recognized. Both human and technological factors contribute to user satisfaction. This exploratory study considers these variables by comparing emergency medicine physician experiences with EHRs in the United States and Norway. Objective This study is unique as it aims to compare individual experiences with EHRs. It creates an opportunity to expand perspective, challenge the unknown, and explore how this technology affects clinicians globally. Research often highlights the challenge that health information technology has created for users: Are the negative consequences of this technology shared among countries? Does it affect medical practice? What determines user satisfaction? Can this be measured internationally? Do specific factors account for similarities or differences? This study begins by investigating these questions by comparing cohort experiences. Fundamental differences between nations will also be addressed. Methods We used semistructured, participant-driven, in-depth interviews (N=12) for data collection in conjunction with ethnographic observations. The conversations were recorded and transcribed. Texts were then analyzed using NVivo software (QSR International) to develop codes for direct comparison among countries. Comprehensive understanding of the data required triangulation, specifically using thematic and interpretive phenomenological analysis. Narrative analysis ensured appropriate context of the NVivo (QSR International) query results. Results Each interview resulted in mixed discussions regarding the benefits and disadvantages of EHRs. All the physicians recognized health care’s dependence on this technology. In Norway, physicians perceived more benefits compared with those based in the United States. Americans reported fewer benefits and disproportionally high disadvantages. Both cohorts believed that EHRs have increased user workload. However, this was mentioned 2.6 times more frequently by Americans (United States [n=40] vs Norway [n=15]). Financial influences regarding health information technology use were of great concern for American physicians but rarely mentioned among Norwegian physicians (United States [n=37] vs Norway [n=6]). Technology dysfunctions were the most common complaint from Norwegian physicians. Participants from each country noted increased frustration among older colleagues. Conclusions Despite differences spanning geographical, organizational, and cultural boundaries, much is to be learned by comparing individual experiences. Both cohorts experienced EHR-related frustrations, although etiology differed. The overall number of complaints was significantly higher among American physicians. This study augments the idea that policy, regulation, and administration have compelling influence on user experience. Global EHR optimization requires additional investigation, and these results help to establish a foundation for future research.

Optimising the educational value of indirect patient care

“…For example, cardiology, internal medicine and orthopaedic specialists similarly spend 50% of their time on indirect patient activities 3 . The same trend has been reported in psychiatry, 21 intensive care 22 and emergency medicine 23,24 . These findings are consistent across high income countries where EHR use is common, including Australia, 25 Germany 26 and the United Kingdom 23 .…”

“…3 The same trend has been reported in psychiatry, 21 intensive care 22 and emergency medicine. 23,24 These findings are consistent across high income countries where EHR use is common, including Australia, 25 Germany 26 and the United Kingdom. 23 IPCAs may be especially taxing for family physicians.…”

The Environmental Impacts of Electronic Medical Records Versus Paper Records at a Large Eye Hospital in India: Life Cycle Assessment Study

“…Switching entirely away from paper may result in increased emissions from computer equipment or electricity, but it could reduce the remaining impacts from paper and toner production. A longer-term follow-up study may help assess environmental impacts after the EMR system has been fully implemented [ 35 ]. Examples of fuller use of the EMR system include barcode scanners for noting sterilization, devices that allow patients to sign consent forms digitally, or increased training for staff to increase their comfort levels with the EMR system.…”

Understanding the perceived role of electronic health records and workflow fragmentation on clinician documentation burden in emergency departments

“…Evidence suggests that electronic health record (EHR) design and workflows fail to optimally meet the needs of ED workflows 9–11 —their incongruencies often leading to excess work and time-consuming workarounds. 11 EHR configurations (eg, supporting regulatory compliance and quality improvement efforts) have intensified ED physician 9 , 12 , 13 and nurse 14 workload, particularly, noncare-related documentation. Consistent with Cohen et al, 15 we define EHR documentation burden as additional work (ie, documentation or actions) performed in the EHR beyond that which is essential for “good” clinical care.…”

“… 25–28 Concurrently, US-based research has predominately focused on the quantification of ED work using direct observation methods 9 , 10 , 13 , 14 , 29–32 and retrospective data analyses, 33–36 and on the use of surveys to assess ED clinician sentiment. 30 , 34 Qualitative research on ED clinician EHR use has examined overall satisfaction, the effect of EHR usability and policy on clinical workflows, 12 , 37 and their perceptions of EHR clinical documentation 10 , 11 ; however, these studies exclusively highlight physician experiences. To our best knowledge, no qualitative studies have investigated the role of EHRs on clinician documentation burden among US prescribing providers and nurses.…”