ICMCC

the international council on medical & care compunetics

science pages

18
April, 2014
Friday

Gradual electronic health record implementation: new insights on physician and patient adaptation

Abstract

PURPOSE:
Although there is significant 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.

METHODS:
We 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 office 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 benefits were found. Physicians appeared to become comfortable with the “third actor” in the room, and nursing and office staff resistance to EHR implementation was ameliorated with improved work efficiencies. 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 flow improved with EHR implementation. Gradual EHR implementation may help support the development of beneficial physician and staff adaptations, while maintaining positive patient-physician relationships and fostering the sharing of medical information.

Shield RR, Goldman RE, Anthony DA, Wang N, Doyle RJ, Borkan J. Gradual electronic health record implementation: new insights on physician and patient adaptation. Ann Fam Med. 2010 Aug;8(4):316-326.

21 July 2010

Bibliographic Data

Title:

Gradual electronic health record implementation: new insights on physician and patient adaptation

Author(s):

Shield, Renée R.; Goldman, Roberta E.; Anthony, David A.; Wang, Nina; Doyle, Richard J.; Borkan, Jeffrey

Journal

Annals of Family Medicine, 8(4), pp. 316-326
(2010-07)

URL:

Full article

DOI:

10.1370/afm.1136

PMID:

20644186

Keyword(s):

Electronic Health Records, Implementation, Patient Satisfaction, Physician-Patient Relationship, United States

Citation:
Shield RR, Goldman RE, Anthony DA, Wang N, Doyle RJ, Borkan J. Gradual electronic health record implementation: new insights on physician and patient adaptation. Ann Fam Med. 2010 Aug;8(4):316-326.

Other Publications

In ICMCC Database

All Annals of Family Medicine articles (11).

Discussion




Back to Science Pages

Back to News Page

Miscellaneous

Affiliated University Institutes

Brown University - Warren Alpert Medical School - Department of Family Medicine, USA

Related science in ICMCC Database

The electronic patient record in primary care – regression or progression? A cross sectional study
Hippisley-Cox, Julia et al, BMJ, 2003;326, 2003-06-28

Physicians, Patients, and the Electronic – Health Record: An Ethnographic Analysis
Ventres, William et al, Annals of Family Medicine, 4(2), 2006-03

Implementation and use of an electronic health record within the Indian Health Service
Sequist TD et al, J Am Med Inform Assoc, 14(2), 2007-01-09

Why facilitate patient access to medical records
Ferreira A et al, Medical and Care Compunetics 4, 2007, 2007-06

Information technology comes to medicine
Blumenthal D, Glaser J. N Engl J Med, 356(24), 2007-06-17

Whose Record Is It Anyway? Putting Patients’ Interests at the Heart of the Implementation and Use of Electronic Medical Records
Mador, Rebecca L. et al, ElectronicHealthcare, 7(2), 2008

Doctor, patient and computer-A framework for the new consultation
Pearce, Christopher et al, International Journal of Medical Informatics, 78(1), 2008-08-27

Primary Care Physicians’ Experience with Electronic Medical Records: Barriers to Implementation in a Fee-for-Service Environment
Ludwick, Dave A., and John Doucette, International Journal of Telemedicine and Applications, 2009, Article ID 853524, 2009

Failure of electronic medical records in Canada: a failure of policy or a failure of technology?
Keshavjee, Karim et al, Advances in Information Technology and Communication in Health, 2009, 2009

Primary health care teams’ experience of electronic medical record use after adoption
Denomme LB et al, Family Medicine, 43(9), 2011-10

PubMed

Renée R. Shield
Roberta E. Goldman
David A. Anthony
Nina Wang
Richard J. Doyle
Jeffrey Borkan

Google Scholar

Renée R. Shield
Roberta E. Goldman
David A. Anthony
Nina Wang
Richard J. Doyle
Jeffrey Borkan

subscribe

ICMCC is member of

IFMBE

WABT

© ICMCC 2004-2011

Log in