Two-year longitudinal assessment of physicians’ perceptions after replacement of a longstanding homegrown electronic health record: does a J-curve of satisfaction really exist?

Abstract

This report describes a 2-year prospective, longitudinal survey of attending physicians in 3 clinical areas (family medicine, general pediatrics, internal medicine) who experienced a transition from a homegrown electronic health record (EHR) to a vendor EHR. Participants were already highly familiar with using EHRs. Data were collected 1 month before and 3, 6, 13, and 25 months post implementation. Our primary goal was to determine if perceptions followed a J-curve pattern in which they initially dropped but eventually surpassed baseline measures. A J-curve was not found for any measures, including workflow, safety, communication, and satisfaction. Only the reminders and alerts measure dropped and then returned to baseline (U-curve); a few remained flatlined. Most dropped and remained below baseline (L-curve). The only measure that remained above baseline was documenting in the exam room with the patient. This study adds to the literature about current controversies surrounding EHR adoption and physician satisfaction.

Two years of unintended consequences: introducing an electronic health record system in a hospice in Scotland

“…This period of decline is better theorised within the ‘J‐curve’ literature (Hanauer et al . ). The J‐curve predicts a period of decline prior to improvement.…”

“…Current literature including this study suggests that this process takes at least two years (Hanauer et al . ).…”

“…Hanauer et al . () hypothesised that the J‐curve would explain adoption of a new EHR in their longitudinal study. Interestingly, they found that this theory also failed to account for their data.…”

“…Whilst there have been previous studies examining the impact of implementation of EHR on physicians (Hanauer et al . ), and qualitative explorations of the impact on nurses (Gephart et al . ), as far as we know this is the first prospective mixed‐methods longitudinal study examining the impact of implementation of EHR on all staff within a single organisation, a hospice in Scotland.…”

When hospitals switch to electronic records

“…12 Although that additional effort was unmeasured here, it may be important in understanding the widespread dissatisfaction with health information technology among frontline providers. 13 For example, mortality and readmissions would likely not change much if some new intervention forced caregivers to do all their work standing on one leg. The lack of obvious failure in such a circumstance would not support a conclusion that the one leg policy was unproblematic; and it would not be surprising that frontline workers hated it, despite the lack of "evidence" of problems.…”