A Hospital-wide Transition from Paper to Digital Problem-oriented Clinical Notes. A Descriptive History and Cross-sectional Survey of Use, Usability, and Satisfaction

Overview

Journal Appl Clin Inform

Publisher Thieme

Specialties Health Services
Medical Informatics

Date 2017 May 18

PMID 28512662

Citations 4

Authors

Felix H J M Cillessen

Pieter F de Vries Robbe

Marion C J Biermans

Affiliations

Soon will be listed here.

Abstract

Objectives: To evaluate the use, usability, and physician satisfaction of a locally developed problem-oriented clinical notes application that replaced paper-based records in a large Dutch university medical center.

Methods: Using a clinical notes database and an application event log file and a cross-sectional survey of usability, authors retrospectively analyzed system usage for medical specialties, users, and patients over 4 years. A standardized questionnaire measured usability. Authors analyzed the effects of sex, age, professional experience, training hours, and medical specialty on user satisfaction via univariate analysis of variance. Authors also examined the correlation between user satisfaction in relation to users' intensity of use of the application.

Results: In total 1,793 physicians used the application to record progress notes for 219,755 patients. The overall satisfaction score was 3.2 on a scale from 1 (highly dissatisfied) to 5 (highly satisfied). A statistically significant difference occurred in satisfaction by medical specialty, but no statistically significant differences in satisfaction took place by sex, age, professional experience, or training hours. Intensity of system use did not correlate with physician satisfaction.

Conclusions: By two years after the start of the implementation, all medical specialties utilized the clinical notes application. User satisfaction was neutral (3.2 on a 1-5 scale). Authors believe that the significant factors facilitating this transition mirrored success factors reported by other groups: a generic, consistent, and transparent design of the application; intensive collaboration; continuous monitoring; and an incremental rollout.

Citing Articles

Challenges and Opportunities to Improve the Clinician Experience Reviewing Electronic Progress Notes.

Hultman G, Marquard J, Lindemann E, Arsoniadis E, Pakhomov S, Melton G Appl Clin Inform. 2019; 10(3):446-453.

PMID: 31216591 PMC: 6584143. DOI: 10.1055/s-0039-1692164.

Impact of Electronic versus Paper-Based Recording before EHR Implementation on Health Care Professionals' Perceptions of EHR Use, Data Quality, and Data Reuse.

Joukes E, de Keizer N, de Bruijne M, Abu-Hanna A, Cornet R Appl Clin Inform. 2019; 10(2):199-209.

PMID: 30895574 PMC: 6426723. DOI: 10.1055/s-0039-1681054.

Physician Perceptions of the Electronic Problem List in Pediatric Trauma Care.

Hose B, Hoonakker P, Wooldridge A, Brazelton Iii T, Dean S, Eithun B Appl Clin Inform. 2019; 10(1):113-122.

PMID: 30759492 PMC: 6374147. DOI: 10.1055/s-0039-1677737.

Teleconsultation Using Mobile Phones for Diagnosis and Acute Care of Burn Injuries Among Emergency Physicians: Mixed-Methods Study.

Klingberg A, Wallis L, Hasselberg M, Yen P, Fritzell S JMIR Mhealth Uhealth. 2018; 6(10):e11076.

PMID: 30341047 PMC: 6231743. DOI: 10.2196/11076.

References

Payne T, tenBroek A, Fletcher G, Labuguen M . Transition from paper to electronic inpatient physician notes. J Am Med Inform Assoc. 2010; 17(1):108-11. PMC: 2995621. DOI: 10.1197/jamia.M3173. View

Rosenbaum L . Transitional Chaos or Enduring Harm? The EHR and the Disruption of Medicine. N Engl J Med. 2015; 373(17):1585-8. DOI: 10.1056/NEJMp1509961. View

Hanauer D, Branford G, Greenberg G, Kileny S, Couper M, Zheng K . Two-year longitudinal assessment of physicians' perceptions after replacement of a longstanding homegrown electronic health record: does a J-curve of satisfaction really exist?. J Am Med Inform Assoc. 2016; 24(e1):e157-e165. PMC: 7299498. DOI: 10.1093/jamia/ocw077. View

Meeks D, Smith M, Taylor L, Sittig D, Scott J, Singh H . An analysis of electronic health record-related patient safety concerns. J Am Med Inform Assoc. 2014; 21(6):1053-9. PMC: 4215044. DOI: 10.1136/amiajnl-2013-002578. View

Nguyen L, Bellucci E, Nguyen L . Electronic health records implementation: an evaluation of information system impact and contingency factors. Int J Med Inform. 2014; 83(11):779-96. DOI: 10.1016/j.ijmedinf.2014.06.011. View

Ellsworth M, Dziadzko M, OHoro J, Farrell A, Zhang J, Herasevich V . An appraisal of published usability evaluations of electronic health records via systematic review. J Am Med Inform Assoc. 2016; 24(1):218-226. PMC: 7654077. DOI: 10.1093/jamia/ocw046. View

Manchikanti L, Benyamin R, Falco F, Hirsch J . Metamorphosis of medicine in the United States: a carrot and stick policy of electronic medical records. Pain Physician. 2014; 17(6):E671-80. View

Ajami S, Bagheri-Tadi T . Barriers for Adopting Electronic Health Records (EHRs) by Physicians. Acta Inform Med. 2013; 21(2):129-34. PMC: 3766548. DOI: 10.5455/aim.2013.21.129-134. View

OConnell R, Cho C, Shah N, Brown K, Shiffman R . Take note(s): differential EHR satisfaction with two implementations under one roof. J Am Med Inform Assoc. 2003; 11(1):43-9. PMC: 305457. DOI: 10.1197/jamia.M1409. View

10.

Rosenbloom S, Denny J, Xu H, Lorenzi N, Stead W, Johnson K . Data from clinical notes: a perspective on the tension between structure and flexible documentation. J Am Med Inform Assoc. 2011; 18(2):181-6. PMC: 3116264. DOI: 10.1136/jamia.2010.007237. View

11.

Jones S, Rudin R, Perry T, Shekelle P . Health information technology: an updated systematic review with a focus on meaningful use. Ann Intern Med. 2014; 160(1):48-54. DOI: 10.7326/M13-1531. View

12.

Ancker J, Kern L, Edwards A, Nosal S, Stein D, Hauser D . How is the electronic health record being used? Use of EHR data to assess physician-level variability in technology use. J Am Med Inform Assoc. 2014; 21(6):1001-8. PMC: 4215048. DOI: 10.1136/amiajnl-2013-002627. View

13.

Jia-lin L, Siru L, Fei L . Physician satisfaction with electronic medical record in a huge hospital (China). Stud Health Technol Inform. 2013; 192:920. View

14.

Friedberg M, Chen P, Van Busum K, Aunon F, Pham C, Caloyeras J . Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy. Rand Health Q. 2017; 3(4):1. PMC: 5051918. View

15.

Bossen C . Evaluation of a computerized problem-oriented medical record in a hospital department: does it support daily clinical practice?. Int J Med Inform. 2006; 76(8):592-600. DOI: 10.1016/j.ijmedinf.2006.04.007. View

16.

Jamoom E, Beatty P, Bercovitz A, Woodwell D, Palso K, Rechtsteiner E . Physician adoption of electronic health record systems: United States, 2011. NCHS Data Brief. 2012; (98):1-8. View

17.

Ammenwerth E, Spotl H . The time needed for clinical documentation versus direct patient care. A work-sampling analysis of physicians' activities. Methods Inf Med. 2009; 48(1):84-91. View

18.

MELLNER C, Selander H, Wolodarski J . The computerized problem-oriented medical record at Karolinska Hospital -- format and function, users' acceptance and patient attitude to questionnaire --. Methods Inf Med. 1976; 15(1):11-20. View

19.

Wright E, Marvel J . Electronic health records: postadoption physician satisfaction and continued use. Health Care Manag (Frederick). 2012; 31(3):259-67. DOI: 10.1097/HCM.0b013e3182619e90. View

20.

Bowman S . Impact of electronic health record systems on information integrity: quality and safety implications. Perspect Health Inf Manag. 2013; 10:1c. PMC: 3797550. View