Perceptions of allied health staff of the implementation of an integrated electronic medical record across regional and metropolitan settings
Maria Schwarz
A B E , Anne Coccetti A , Michael Draheim A C and Gail Gordon D
+ Author Affiliations
- Author Affiliations
A Logan Hospital, Metro South Hospital and Health Service, Queensland Health, Armstrong Road and Loganlea Road, Meadowbrook, Qld 4131, Australia.
B School of Health and Rehabilitation Sciences, The University of Queensland, Level 3, Therapies Annexe (84A), St Lucia, Qld 4072, Australia.
C UQ Business School, The University of Queensland, Level 2, Colin Clark Building (#39), St Lucia, Qld 4072, Australia.
D Bayside Health Services, Metro South Hospital and Health Service, Queensland Health, Weippin Street, Cleveland, Qld 4163, Australia.
E Corresponding author. Email: maria.schwarz@health.qld.gov.au
Australian Health Review 44(6) 965-972 https://doi.org/10.1071/AH19024
Submitted: 25 January 2019 Accepted: 29 January 2020 Published: 9 October 2020
Abstract
Objective The aim of this study was to investigate the perceptions of allied health professionals (AHPs) to implementation of an integrated electronic medical record (EMR) across both regional and metropolitan settings.
Methods The study was conducted as a cross-sectional electronic survey. AHPs working at three hospital sites within Queensland Health were sent an electronic survey link. Participation was voluntary and recruitment via a snowball sampling technique was encouraged. Responses were analysed descriptively.
Results In all, 104 responders completed the survey. Responders were distributed across three sites within the selected health service, with most (75%; n = 78) being at the largest site. Physiotherapy accounted for the largest number of responders (22%). Most responders were female (87%; n = 90) and between 20 and 40 years of age (68%; n = 71). On a scale from 0 (being anxious) to 100 (being excited), at the time EMR implementation was announced, there was a trend towards excitement (mean score 59). The most commonly reported factor hindering EMR implementation was the opportunity to practice with EMR (34%), whereas clinical ‘change champions’ were reported as the most common facilitators (61%). Overall, 60% of responders were very satisfied or satisfied with the EMR, but limited effects on efficiency and patient care were reported.
Conclusions The results suggest an overall positive response to EMR implementation. Minimal staff reported effects such as stress or anxiety in the workplace related to EMR implementation, and a perception of ‘comfort’ was cited once EMR was part of usual practice. However, responders did not report a significant effect on speed, efficiency or quality of patient care following EMR implementation.
What is known about the topic? A growing body of literature exists regarding the perceptions of staff (particularly medical officers) in moving towards EMRs, but there is limited evidence regarding the perceptions of AHPs, and the barriers and facilitators to this change.
What does this paper add? This paper presents a novel perspective regarding the perceptions of AHPs regarding the implementation of an EMR and provides a perspective of the barriers and facilitators that supported a smooth transition at three sites.
What are the implications for practitioners? Despite being a large-scale service change, the introduction of an EMR did not significantly increase AHPs’ subjective feelings of anxiety. Services considering EMR implementation should invest in the provision of timely information, ‘at-elbow’ support and opportunities to practice the new system.
References
[1] Scott IA, Sullivan C, Staib A. Going digital: a checklist in preparing for hospital-wide electronic medical record implementation and digital transformation. Aust Health Rev 2018; 24 302–13.[2] Burridge L, Foster M, Jones R, Geraghty T, Atresh S. Person-centred care in a digital hospital: observations and perspectives from a specialist rehabilitation setting. Aust Health Rev 2018; 42 529–35.
| 29081349PubMed |
[3] Chaudhry B, Wang J, Wu S, Maglione M, Mojica W, Roth E, Morton S, Shekell PG. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med 2006; 144 742–52.
| Systematic review: impact of health information technology on quality, efficiency, and costs of medical care.Crossref | GoogleScholarGoogle Scholar | 16702590PubMed |
[4] Jha AK, DesRoches CM, Campbell EG, Donelan K, Rao SR, Ferris TG, Shields A, Rosenbaum S, Blumenthal D. Use of electronic health records in US hospitals. N Engl J Med 2009; 360 1628–38.
| Use of electronic health records in US hospitals.Crossref | GoogleScholarGoogle Scholar | 19321858PubMed |
[5] Skolnik NS, Timko M, Myers C. A view from the trenches: primary care physicians on electronic health records. In: Skolnik NS, editor. Electronic medical records. New York: Springer; 2011. pp. 15–36.
[6] Keasberry J, Scott IA, Sullivan C, Staib A, Ashby R. Going digital: a narrative overview of the clinical and organisational impacts of eHealth technologies in hospital practice. Aust Health Rev 2018; 41 646–64.
[7] Eden R, Burton-Jones A, Scott I, Staib A, Sullivan C. Effects of eHealth on hospital practice: synthesis of the current literature. Aust Health Rev 2018; 42 568–78.
| 29986809PubMed |
[8] Boonstra A, Broekhuis M. Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions. BMC Health Serv Res 2010; 10 231
| Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions.Crossref | GoogleScholarGoogle Scholar | 20691097PubMed |
[9] Houser SH, Johnson LA. Perceptions regarding electronic health record implementation among health information management professionals in Alabama: a statewide survey and analysis. Perspect Health Inf Manag 2008; 5 6
| 18504505PubMed |
[10] Wylie MC, Baier RR, Gardner RL. Perceptions of electronic health record implementation: a statewide survey of physicians in Rhode Island. Am J Med 2014; 127 1010.e21–e27.
| Perceptions of electronic health record implementation: a statewide survey of physicians in Rhode Island.Crossref | GoogleScholarGoogle Scholar |
[11] Darbyshire P. ‘Rage against the machine?’: nurses’ and midwives’ experiences of using computerized patient information systems for clinical information. J Clin Nurs 2004; 13 17–25.
| ‘Rage against the machine?’: nurses’ and midwives’ experiences of using computerized patient information systems for clinical information.Crossref | GoogleScholarGoogle Scholar | 14687289PubMed |
[12] Terry AL, Brown JB, Denomme LB, Thind A, Stewart M. Perspectives on electronic medical record implementation after two years of use in primary health care practice. J Am Board Fam Med 2012; 25 522–7.
| Perspectives on electronic medical record implementation after two years of use in primary health care practice.Crossref | GoogleScholarGoogle Scholar | 22773720PubMed |
[13] Likourezos A, Chalfin DB, Murphy DG, Sommer B, Darcy K, Davidson SJ. Physician and nurse satisfaction with an electronic medical record system. J Emerg Med 2004; 27 419–24.
| Physician and nurse satisfaction with an electronic medical record system.Crossref | GoogleScholarGoogle Scholar | 15498630PubMed |
[14] Schenk EC, Ward-Barney E, Estill P, Goss L, Shreffler-Grant J. RN perceptions of a newly adopted electronic health record. J Nurs Adm 2016; 46 139–45.
| RN perceptions of a newly adopted electronic health record.Crossref | GoogleScholarGoogle Scholar | 26906518PubMed |
[15] Rathert C, Mittler JN, Banerjee S, McDaniel J. Patient-centered communication in the era of electronic health records: what does the evidence say? Patient Educ Couns 2017; 100 50–64.
| 27477917PubMed |
[16] Kuziemsky C, Randell R, Borycki EJ. Understanding unintended consequences and health information technology. Yearb Med Inform 2016; 25 53–60.
[17] Heisey-Grove D, Danehy L-N, Consolazio M, Lynch K, Mostashari F. A national study of challenges to electronic health record adoption and meaningful use. Med Care 2014; 52 144–8.
| A national study of challenges to electronic health record adoption and meaningful use.Crossref | GoogleScholarGoogle Scholar | 24309669PubMed |
[18] Brooks R, Grotz C. Implementation of electronic medical records: how healthcare providers are managing the challenges of going digital. J Bus Econ Res 2010; 8 73–84.
| Implementation of electronic medical records: how healthcare providers are managing the challenges of going digital.Crossref | GoogleScholarGoogle Scholar |
[19] Boonstra A, Versluis A, Vos JF. Implementing electronic health records in hospitals: a systematic literature review. BMC Health Serv Res 2014; 14 370
| Implementing electronic health records in hospitals: a systematic literature review.Crossref | GoogleScholarGoogle Scholar | 25190184PubMed |
[20] Berg M. Implementing information systems in health care organizations: myths and challenges. Int J Med Inform 2001; 64 143–56.
| 11734382PubMed |
[21] Aarts J, Berg M, editors. A tale of two hospitals: a sociotechnical appraisal of the introduction of computerized physician order entry in two Dutch hospitals. Amsterdam: Medinfo; 2004.
[22] Harrison MI, Koppel R, Bar-Lev S. Unintended consequences of information technologies in health care – an interactive sociotechnical analysis. J Am Med Inform Assoc 2007; 14 542–9.
| 17600093PubMed |
[23] Cucciniello M, Lapsley I, Nasi G, Pagliari C. Understanding key factors affecting electronic medical record implementation: a sociotechnical approach. BMC Health Serv Res 2015; 15 268
| 26184405PubMed |
[24] Madore A, Rosenberg J, Muyindike WR, Bangsberg DR, Bwana MB, Martin JN, Kanyesigye M, Weintraub R. Implementation of electronic medical records requires more than new software: lessons on integrating and managing health technologies from Mbarara, Uganda. Healthcare 2015; 3 264–69.
| 26699355PubMed |
[25] Lluch M. Healthcare professionals’ organisational barriers to health information technologies – a literature review. Int J Med Inform 2011; 80 849–62.
| Healthcare professionals’ organisational barriers to health information technologies – a literature review.Crossref | GoogleScholarGoogle Scholar | 22000677PubMed |
[26] Sullivan C, Staib A. Digital disruption ‘syndromes’ in a hospital: important considerations for the quality and safety of patient care during rapid digital transformation. Aust Health Rev 2018; 42 294–8.
| 28514640PubMed |
[27] Heeks R. Health information systems: failure, success and improvisation. Int J Med Inform 2006; 75 125–37.
| Health information systems: failure, success and improvisation.Crossref | GoogleScholarGoogle Scholar | 16112893PubMed |
[28] Meinert DB, Peterson D. Perceived importance of EMR functions and physician characteristics. J Syst Inf Technol 2009; 11 57–70.
| Perceived importance of EMR functions and physician characteristics.Crossref | GoogleScholarGoogle Scholar |
[29] Butler RJ, Johnson W. Rating the digital help: electronic medical records, software providers, and physicians. Int J Health Econ Manag 2016; 16 269–83.
| Rating the digital help: electronic medical records, software providers, and physicians.Crossref | GoogleScholarGoogle Scholar | 27878677PubMed |
[30] Guttmacher S, Tiersten D. Digital health records: a viewpoint on impact on medical practice and potential implications for both communication and future research. J Commun Healthc 2014; 7 5–7.
| Digital health records: a viewpoint on impact on medical practice and potential implications for both communication and future research.Crossref | GoogleScholarGoogle Scholar |
[31] Gomes M, Hash P, Orsolini L, Watkins A, Mazzoccoli A. Connecting professional practice and technology at the bedside: nurses’ beliefs about using an electronic health record and their ability to incorporate professional and patient-centered nursing activities in patient care. Comput Inform Nurs 2016; 34 578–86.
| Connecting professional practice and technology at the bedside: nurses’ beliefs about using an electronic health record and their ability to incorporate professional and patient-centered nursing activities in patient care.Crossref | GoogleScholarGoogle Scholar | 27496045PubMed |
[32] Zarcadoolas C, Vaughon W, Czaja S, Levy J, Rockoff M. Consumers’ perceptions of patient-accessible electronic medical records. J Med Internet Res 2013; 15 e168
| Consumers’ perceptions of patient-accessible electronic medical records.Crossref | GoogleScholarGoogle Scholar | 23978618PubMed |
[33] Liu J, Luo L, Zhang R, Huang T. Patient satisfaction with electronic medical/health record: a systematic review. Scand J Caring Sci 2013; 27 785–91.
| Patient satisfaction with electronic medical/health record: a systematic review.Crossref | GoogleScholarGoogle Scholar | 23181421PubMed |
[34] Rozenblum R, Donzé J, Hockey PM, Guzdar E, Labuzetta MA, Zimlichman E, Bates DW. The impact of medical informatics on patient satisfaction: a USA-based literature review. Int J Med Inform 2013; 82 141–58.
| The impact of medical informatics on patient satisfaction: a USA-based literature review.Crossref | GoogleScholarGoogle Scholar | 23332922PubMed |
[35] Rutten LJF, Vieux SN, St Sauver J, Arora NK, Moser RP, Beckjord EB, Hesse B. Patient perceptions of electronic medical records use and ratings of care quality. Patient Relat Outcome Meas 2014; 5 17–23.
| Patient perceptions of electronic medical records use and ratings of care quality.Crossref | GoogleScholarGoogle Scholar |
[36] Hailey D, Yu D, Munyisia E. Pre-implementation investigation of the readiness of allied health professionals to adopt electronic health records. Stud Health Technol Inform 2014; 204 47–53.
| Pre-implementation investigation of the readiness of allied health professionals to adopt electronic health records.Crossref | GoogleScholarGoogle Scholar | 25087526PubMed |
[37] Allied Health Professions Office of Queensland. 2017–18 year in review. Brisbane: Queensland Health; 2017.
[38] Black AD, Car J, Pagliari C, Anandan C, Cresswell K, Bokun T, McKinstry B, Procter R, Majeed A, Sheikh A. The impact of eHealth on the quality and safety of health care: a systematic overview. PLoS Med 2011; 8 e1000387
| The impact of eHealth on the quality and safety of health care: a systematic overview.Crossref | GoogleScholarGoogle Scholar | 21267058PubMed |
[39] Moore AN, Rothpletz A, Preminger J. The effect of chronological age on the acceptance of Internet-based hearing health care. Am J Audiol 2015; 24 280–3.
| The effect of chronological age on the acceptance of Internet-based hearing health care.Crossref | GoogleScholarGoogle Scholar | 26649530PubMed |
[40] Ward MM, Vartak SS, Schwichtenberg ST, Wakefield SD. Nurses’ perceptions of how clinical information system implementation affects workflow and patient care. Comput Inform Nurs 2011; 29 502–11.
| 21825972PubMed |
[41] Simon SR, Keohane CA, Amato M, Coffey M, Cadet B, Zimlichman E, Bates DW. Lessons learned from implementation of computerized provider order entry in 5 community hospitals: a qualitative study. BMC Med Inform Decis Mak 2013; 13 67
| Lessons learned from implementation of computerized provider order entry in 5 community hospitals: a qualitative study.Crossref | GoogleScholarGoogle Scholar | 23800211PubMed |
[42] Weir C, Lincoln M, Roscoe D, Turner C, Moreshead G. Dimensions associated with successful implementation of a hospital based integrated order entry system. Proc Annu Symp Comput Appl Med Care 1994: 653–57. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2247902/ [verified 27 August 2020].
[43] Embi PJ, Payne PR. Clinical research informatics: challenges, opportunities and definition for an emerging domain. J Am Med Inform Assoc 2009; 16 316–27.
| Clinical research informatics: challenges, opportunities and definition for an emerging domain.Crossref | GoogleScholarGoogle Scholar | 19261934PubMed |
[44] Prokosch H-U, Ganslandt T. Perspectives for medical informatics. Methods Inf Med 2009; 48 38–44.
| Perspectives for medical informatics.Crossref | GoogleScholarGoogle Scholar | 19151882PubMed |
[45] Wasserman RC. Electronic medical records (EMRs), epidemiology, and epistemology: reflections on EMRs and future pediatric clinical research. Acad Pediatr 2011; 11 280–7.
| Electronic medical records (EMRs), epidemiology, and epistemology: reflections on EMRs and future pediatric clinical research.Crossref | GoogleScholarGoogle Scholar | 21622040PubMed |
[46] Yoon-Flannery K, Zandieh S, Kuperman G, Langsam D, Hyman D, Kaushal R. A qualitative analysis of an electronic health record (EHR) implementation in an academic ambulatory setting. Inform Prim Care 2008; 16 277–84.
| A qualitative analysis of an electronic health record (EHR) implementation in an academic ambulatory setting.Crossref | GoogleScholarGoogle Scholar | 19192329PubMed |
[47] Yamamoto K, Sumi E, Yamazaki T, Asai K, Yamori M, Teramukai S, Bessho K, Yokode M, Fukushima M. A pragmatic method for electronic medical record-based observational studies: developing an electronic medical records retrieval system for clinical research. BMJ Open 2012; 2 e001622
| A pragmatic method for electronic medical record-based observational studies: developing an electronic medical records retrieval system for clinical research.Crossref | GoogleScholarGoogle Scholar | 23117567PubMed |
