Electronic Health Record Adoption – Maybe It’s not about the Money

L. Grabenbauer; A. Skinner; J. Windle

doi:10.4338/ACI-2011-05-RA-0033

Applied Clinical Informatics, Table of Contents

Appl Clin Inform 2011; 02(04): 460-471
DOI: 10.4338/ACI-2011-05-RA-0033

Research Article

Schattauer GmbH

Electronic Health Record Adoption – Maybe It’s not about the Money

Physician Super-Users, Electronic Health Records and Patient Care

L. Grabenbauer

¹University of Nebraska Medical Center, USA

,

A. Skinner

¹University of Nebraska Medical Center, USA

,

J. Windle

¹University of Nebraska Medical Center, USA

› Author Affiliations

Abstract

Summary

Objective: The slow adoption of electronic health record (EHR) systems has been linked to physician resistance to change and the expense of EHR adoption. This qualitative study was conducted to evaluate benefits, and clarify limitations of two mature, robust, comprehensive EHR Systems by tech-savvy physicians where resistance and expense are not at issue.

Methods: Two EHR systems were examined – the paperless VistA / Computerized Patient Record System used at the Veterans‘ Administration, and the General Electric Centricity Enterprise system used at an academic medical center. A series of interviews was conducted with 20 EHR-savvy multi-institutional internal medicine (IM) faculty and house staff. Grounded theory was used to analyze the transcribed data and build themes. The relevance and importance of themes were constructed by examining their frequency, convergence, and intensity.

Results: Despite eliminating resistance to both adoption and technology as drivers of acceptance, these two robust EHR’s are still viewed as having an adverse impact on two aspects of patient care, physician workflow and team communication. Both EHR’s had perceived strengths but also significant limitations and neither were able to satisfactorily address all of the physicians’ needs.

Conclusion: Difficulties related to physician acceptance reflect real concerns about EHR impact on patient care. Physicians are optimistic about the future benefits of EHR systems, but are frustrated with the non-intuitive interfaces and cumbersome data searches of existing EHRs.

Keywords

Adoption - electronic health record

Full Text

References

References
1 The White House –Press Office –Remarks of President Barack Obama –Address to Joint Session of Congress [Internet]. Washington: The White House; [updated 2009 Feb 24; cited 2011 Jul 11]. Available from http://www.whitehouse.gov/the_press_office/Remarks-of-President-Barack-Obama-Address-to-Joint-Session-of-Congress/.
2 Executive Order 13410: Promoting Quality and Efficient Health Care in Federal Government Administered or Sponsored Health Care Programs [Internet]. Washington: Federal Register; [updated 2006 Aug 26; cited 2011 Jul 11]. Available from http://edocket.access.gpo.gov/2006/pdf/06–7220.pdf.
3 Koshy R. Navigating the information technology highway: computer solutions to reduce errors and enhance patient safety. Transfusion 2005; 45 (04) 189S-205S.
4 Safety,Committee on Data Standards for Patient.. Patient Safety: Achieving a new standard for care. 1st ed.: National Academies Press; 2004
5 National Academy of Sciences.. Key capabilities of an electronic health record. 2003
6 Bates DW, Cohen M, Leape LL, Overhage JM, Shabot MM, Sheridan T. Reducing the frequency of errors in medicine using information technology. J Am Med Inform Assoc 2001; 8 (04) 299-308.
7 Institute of Medicine Committee on Quality of Health Care in America.. To err is human: Building a safer health system. 1st ed.: National Academies Press; 2000
8 Ford EW, Menachemi N, Peterson LT, Huerta TR. Resistance is futile: but it is slowing the pace of EHR adoption nonetheless. J Am Med Inform Assoc 2009; 16 (03) 274-281.
9 Abdolrasulnia M, Menachemi N, Shewchuk RM, Ginter PM, Duncan WJ, Brooks RG. Market effects on electronic health record adoption by physicians. Health Care Manage Rev 2008; 33 (03) 243-252.
10 Balfour 3rd DC, Evans S, Januska J, Lee HY, Lewis SJ, Nolan SR. et al. Health information technology –results from a roundtable discussion. J Manag Care Pharm 2009; 15 (1 Suppl A) 10-17.
11 Ford EW, Menachemi N, Phillips MT. Predicting the adoption of electronic health records by physicians: when will health care be paperless?. J Am Med Inform Assoc 2006; 13 (01) 106-112.
12 Geibert RC. Using diffusion of innovation concepts to enhance implementation of an electronic health record to support evidence-based practice. Nurs Adm Q 2006; 30 (03) 203-210.
13 Poissant L, Pereira J, Tamblyn R, Kawasumi Y. The impact of electronic health records on time efficiency of physicians and nurses: a systematic review. J Am Med Inform Assoc 2005; 12 (05) 505-516.
14 Bates DW. Physicians and ambulatory electronic health records. Health Aff (Millwood) 2005; 24 (05) 1180-1189.
15 Menachemi N, Ford EW, Beitsch LM, Brooks RG. Incomplete EHR adoption: late uptake of patient safety and cost control functions. Am J Med Qual 2007; 22 (05) 319-326.
16 Grabenbauer L, Fraser RS, McClay JC, Woelfl N, Thompson CB, Campbell J. et al. Adoption of electronic health records: A qualitative study of academic and private physicians and health administrators. Appl Clin Inf 2011; 2: 165-176. http://dx.doi.org/10.4338/ACI-2011–01-RA-0003.
17 Whitten J, Bentley L. Systems Analysis and Design Methods. 7th ed. McGraw-Hill/Irwin; <SKU> 913464-A10–0073052337; 2005
18 Rogers EM. Diffusion of innovations. New York: Free Press; 1995
19 Lorenzi NM, Kouroubali A, Detmer DE, Bloomrosen M. How to successfully select and implement electronic health records (EHR) in small ambulatory practice settings. BMC Med Inform Decis Mak 2009; 23 9: 15.
20 Halbesleben JR, Wakefield DS, Ward MM, Brokel J, Crandall D. The relationship between super users’ attitudes and employee experiences with clinical information systems. Med Care Res Rev 2009; 66 (01) 82-96.
21 Corbin J, Strauss A. Basics of Qualitative Research: Techniques and procedures for developing grounded theory. 3rd ed.: Sage Publications, Inc; 2007
22 Strauss AL, Corbin JM. Basics of qualitative research :grounded theory procedures and techniques. Newbury Park, Calif.: Sage Publications; 1991
23 Glaser BG, Strauss AL. editors. The discovery of grounded theory : strategies for qualitative research. Chicago: Aldine Pub. Co.; 1967
24 Scalzi T. The VA leads the way in electronic innovations. Nursing 2007; 37 (09) 26-27.
25 Lovis C, Payne TH. Extending the VA CPRS electronic patient record order entry system using natural language processing techniques. Proc AMIA Symp 2000: 517-521.
26 Centricity Enterprise –Healthcare IT Solutions.. General Electric Healthcare; [updated 2011 Jul 11; cited 2011 Jul 11]. Available from: https://www2.gehealthcare.com/portal/site/usen/menuitem.e8b305b80b84c1b4d6354a1074c84130/?vgnextoid=5b83e73922f30210VgnVCM10000024dd1403RCRD&vgnextfmt=default&productid=4b83e73922f30210VgnVCM10000024dd1403____.
27 Lincoln YS, Guba EG. Naturalistic Inquiry. 1st ed.: Sage Publications, Inc; 1985
28 Miles MB, Huberman M. Qualitative data analysis: An expanded sourcebook. 2nd ed.: Sage Publications, Inc;; 1994
29 Blumenthal D. Stimulating the adoption of health information technology. N Engl J Med 2009; 360 (15) 1477-1479.
30 UNMC Internal Documentation. Physician Workflow. 2008
31 Lorenzi NM, Novak LL, Weiss JB, Gadd CS, Unertl KM. Crossing the implementation chasm: a proposal for bold action. J Am Med Inform Assoc 2008; 15 (03) 290-296.
32 Lorenzi NM. Strategies for creating successful local health information infrastructure Initiatives. 2003
33 Lorenzi NM, Riley RT. Managing change: an overview. J Am Med Inform Assoc 2000; 7 (02) 116-124.
34 Lorenzi NM, Riley RT. Organizational issues = change. Int J Med Inform 2003; 69 (2–3) 197-203.
35 Malhotra S, Jordan D, Shortliffe E, Patel VL. Workflow modeling in critical care: piecing together your own puzzle. J Biomed Inform 2007; 40 (02) 81-92.
36 McGrath JM, Arar NH, Pugh JA. The influence of electronic medical record usage on nonverbal communication in the medical interview. Health Informatics J 2007; 13 (02) 105-118.
37 Ash JS, Sittig DF, Poon EG, Guappone K, Campbell E, Dykstra RH. The extent and importance of unintended consequences related to computerized provider order entry. J Am Med Inform Assoc 2007; 14 (04) 415-423.
38 Solet DJ, Norvell JM, Rutan GH, Frankel RM. Lost in translation: challenges and opportunities in physician-to-physician communication during patient handoffs. Acad Med 2005; 80 (12) 1094-1099.
39 Weir CR, Nebeker JR. Critical issues in an electronic documentation system. AMIA Annu Symp Proc 2007: 786-790.
40 Javitt JC. How to succeed in health information technology. Health Aff (Millwood) 2004; Suppl Web Exclusives:W4–321-4.
41 State of the Union [Internet]. Washington: The White House; [updated 2010 Jan 27; cited 2011 Jul 11]. Available from: http://www.whitehouse.gov/the-press-office/remarks-president-state-union-address.
42 Report to the President Realizing the Full Potential of Health Information Technology to Improve Health-care for Americans : The Path Forward [Internet]. Washington: President’s Council of Advisors on Science and Technology; [updated 2010 Dec 8; cited 2011 Jul 11]. Available from: http://www.whitehouse.gov/ sites/default/files/microsites/ostp/pcast-health-it-report.pdf.
43 Blumenthal D, Tavenner M. The “meaningful use” regulation for electronic health records. N Engl J Med 2010; 363 (06) 501-504.