Gradual Electronic Health Record Implementation: New Insights on Physician and Patient Adaptation

Abstract

PURPOSE Although there is signifi cant interest in implementation of electronic health records (EHRs), limited data have been published in the United States about how physicians, staff, and patients adapt to this implementation process. The purpose of this research was to examine the effects of EHR implementation, especially regarding physician-patient communication and behaviors and patients' responses. METHODSWe undertook a 22-month, triangulation design, mixed methods study of gradual EHR implementation in a residency-based family medicine outpatient center. Data collection included participant observation and time measurements of 170 clinical encounters, patient exit interviews, focus groups with nurses, nurse's aides, and offi ce staff, and unstructured observations and interviews with nursing staff and physicians. Analysis involved iterative immersion-crystallization discussion and searches for alternate hypotheses.RESULTS Patient trust in the physician and security in the physician-patient relationship appeared to override most patients' concerns about information technology. Overall, staff concerns about potential deleterious consequences of EHR implementation were dispelled, positive anticipated outcomes were realized, and unexpected benefi ts were found. Physicians appeared to become comfortable with the "third actor" in the room, and nursing and offi ce staff resistance to EHR implementation was ameliorated with improved work effi ciencies. Unexpected advantages included just-in-time improvements and decreased physician time out of the examination room.CONCLUSIONS Strong patient trust in the physician-patient relationship was maintained and work fl ow improved with EHR implementation. Gradual EHR implementation may help support the development of benefi cial physician and staff adaptations, while maintaining positive patient-physician relationships and fostering the sharing of medical information.

Impact of Electronic Medical Record Use on the Patient–Doctor Relationship and Communication: A Systematic Review

“…Seven studies examined both patient perceptions and observed behaviors. 30,31,43,44,48,49,55 Only two studies were interventional in nature. 61,70 Forty-seven of the 53 studies were published after the year 2000, and 19 (35.8 %) were published since 2011.…”

“…While 11 studies [29][30][31]34,37,38,43,44,48,49,55 attempted to correlate objective observations of communication behaviors with patient perceptions of care, only seven of these studies elicited patient perspectives directly. 30,31,43,44,48,49,55 The remaining studies used researcher perceptions of the patient perspective as a proxy.…”

“…30,31,43,44,48,49,55 The remaining studies used researcher perceptions of the patient perspective as a proxy. Studies noted mixed patient perceptions.…”

The Heart of Family Medicine

“…A study by Shield et al, 11 in which residency clinic patients maintained strong trust in the doctor-patient relationship during EHR implementation, convinced one reader that, "if the verdict was not in, it is now. The benefi ts of EHR far outweigh the various costs associated with their implementation."…”

Ethics, Support for Care, Prevention, and What's Important

“…T his issue of the Annals addresses ethical issues, 1,2 the effects of implementing new models of care support, 3,4 prevention, 5 screening, 6-8 and patients' health information-seeking behaviors. 9 It closes with a new approach for calculating the complexity of patient visits 10,11 and a community celebration of the life of a personal physician.…”