Skip to main content
Top
Published in: BMC Medical Informatics and Decision Making 1/2020

Open Access 01-12-2020 | Research article

A qualitative study of physician perspectives on adaptation to electronic health records

Authors: Cynthia J. Sieck, Nicole Pearl, Tiffani J. Bright, Po-Yin Yen

Published in: BMC Medical Informatics and Decision Making | Issue 1/2020

Login to get access

Abstract

Background

Electronic Health Records (EHRs) have the potential to improve many aspects of care and their use has increased in the last decade. Because of this, acceptance and adoption of EHRs is less of a concern than adaptation to use. To understand this issue more deeply, we conducted a qualitative study of physician perspectives on EHR use to identify factors that facilitate adaptation.

Methods

We conducted semi-structured interviews with 9 physicians across a range of inpatient disciplines at a large Academic Medical Center. Interviews were conducted by phone, lasting approximately 30 min, and were transcribed verbatim for analysis. We utilized inductive and deductive methods in our analysis.

Results

We identified 4 major themes related to EHR adaptation: impact of EHR changes on physicians, how physicians managed these changes, factors that facilitated adaptation to using the EHR and adapting to using the EHR in the patient encounter. Within these themes, physicians felt that a positive mindset toward change, providing upgrade training that was tailored to their role, and the opportunity to learn from colleagues were important facilitators of adaptation.

Conclusions

As EHR use moves beyond implementation, physicians continue to be required to adapt to the technology and to its frequent changes. Our study provides actionable findings that allow healthcare systems to focus on factors that facilitate the adaptation process for physicians.
Literature
3.
go back to reference Kruse CS, et al. Adoption factors associated with electronic health record among long-term care facilities: a systematic review. BMJ Open. 2015;5(1):e006615.PubMedPubMedCentralCrossRef Kruse CS, et al. Adoption factors associated with electronic health record among long-term care facilities: a systematic review. BMJ Open. 2015;5(1):e006615.PubMedPubMedCentralCrossRef
4.
go back to reference Meigs, S.L. and M. Solomon, Electronic health record use a bitter pill for many physicians. Perspectives in health information management, 2016. 13(Winter). Meigs, S.L. and M. Solomon, Electronic health record use a bitter pill for many physicians. Perspectives in health information management, 2016. 13(Winter).
6.
go back to reference Blumenthal D, Tavenner M. The “meaningful use” regulation for electronic health records. N Engl J Med. 2010;363(6):501–4.PubMedCrossRef Blumenthal D, Tavenner M. The “meaningful use” regulation for electronic health records. N Engl J Med. 2010;363(6):501–4.PubMedCrossRef
7.
8.
9.
go back to reference Friedberg MW, et al. Factors affecting physician professional satisfaction and their implications for patient care, health systems, and health policy. Rand Health Q. 2014;3(4):1.PubMedPubMedCentral Friedberg MW, et al. Factors affecting physician professional satisfaction and their implications for patient care, health systems, and health policy. Rand Health Q. 2014;3(4):1.PubMedPubMedCentral
11.
go back to reference McAlearney AS, et al. The journey through grief: insights from a qualitative study of electronic health record implementation. Health Serv Res. 2015;50(2):462–88.PubMedCrossRef McAlearney AS, et al. The journey through grief: insights from a qualitative study of electronic health record implementation. Health Serv Res. 2015;50(2):462–88.PubMedCrossRef
12.
go back to reference Gardner RL, et al. Physician stress and burnout: the impact of health information technology. J Am Med Inform Assoc. 2018;26(2):106–14.CrossRef Gardner RL, et al. Physician stress and burnout: the impact of health information technology. J Am Med Inform Assoc. 2018;26(2):106–14.CrossRef
13.
go back to reference Gregory ME, Russo E, Singh H. Electronic health record alert-related workload as a predictor of burnout in primary care providers. Appl Clin Inform. 2017;8(03):686–97.PubMedPubMedCentralCrossRef Gregory ME, Russo E, Singh H. Electronic health record alert-related workload as a predictor of burnout in primary care providers. Appl Clin Inform. 2017;8(03):686–97.PubMedPubMedCentralCrossRef
14.
go back to reference Verhaeghe R, et al. Impact of recurrent changes in the work environment on nurses’ psychological well-being and sickness absence. J Adv Nurs. 2006;56(6):646–56.PubMedCrossRef Verhaeghe R, et al. Impact of recurrent changes in the work environment on nurses’ psychological well-being and sickness absence. J Adv Nurs. 2006;56(6):646–56.PubMedCrossRef
15.
go back to reference Majchrzak A, et al. Technology adaptation: The case of a computer-supported inter-organizational virtual team. MIS Q. 2000; 24(04):569–600.CrossRef Majchrzak A, et al. Technology adaptation: The case of a computer-supported inter-organizational virtual team. MIS Q. 2000; 24(04):569–600.CrossRef
16.
go back to reference Yen P-Y, et al. Health information technology (HIT) adaptation: refocusing on the journey to successful HIT implementation. JMIR Med Inform. 2017;5(3):e28.PubMedPubMedCentralCrossRef Yen P-Y, et al. Health information technology (HIT) adaptation: refocusing on the journey to successful HIT implementation. JMIR Med Inform. 2017;5(3):e28.PubMedPubMedCentralCrossRef
17.
go back to reference Cresswell KM, Bates DW, Sheikh A. Ten key considerations for the successful optimization of large-scale health information technology. J Am Med Inform Assoc. 2016;24(1):182–7.PubMedCrossRef Cresswell KM, Bates DW, Sheikh A. Ten key considerations for the successful optimization of large-scale health information technology. J Am Med Inform Assoc. 2016;24(1):182–7.PubMedCrossRef
18.
go back to reference Donabedian A. Evaluating the quality of medical care. Milbank Mem Fund Q. 1966;44(3):166–206.CrossRef Donabedian A. Evaluating the quality of medical care. Milbank Mem Fund Q. 1966;44(3):166–206.CrossRef
19.
go back to reference Venkatesh V, Bala H. Technology acceptance model 3 and a research agenda on interventions. Decis Sci. 2008;39(2):273–315.CrossRef Venkatesh V, Bala H. Technology acceptance model 3 and a research agenda on interventions. Decis Sci. 2008;39(2):273–315.CrossRef
20.
go back to reference Davis FD. Perceived usefulness, perceived ease of use, and user acceptance of information technology. MIS Q. 1989;13(04):319–40.CrossRef Davis FD. Perceived usefulness, perceived ease of use, and user acceptance of information technology. MIS Q. 1989;13(04):319–40.CrossRef
21.
go back to reference Venkatesh V, Davis FD. A theoretical extension of the technology acceptance model: four longitudinal field studies. Manag Sci. 2000;46(2):186–204.CrossRef Venkatesh V, Davis FD. A theoretical extension of the technology acceptance model: four longitudinal field studies. Manag Sci. 2000;46(2):186–204.CrossRef
22.
go back to reference Nadri H, et al. Factors affecting acceptance of hospital information systems based on extended technology acceptance model: a case study in three paraclinical departments. Appl Clin Inform. 2018;9(02):238–47.PubMedPubMedCentralCrossRef Nadri H, et al. Factors affecting acceptance of hospital information systems based on extended technology acceptance model: a case study in three paraclinical departments. Appl Clin Inform. 2018;9(02):238–47.PubMedPubMedCentralCrossRef
23.
go back to reference Constas MA. Qualitative analysis as a public event: the documentation of category development procedures. Am Educ Res J. 1992;29(2):253–66.CrossRef Constas MA. Qualitative analysis as a public event: the documentation of category development procedures. Am Educ Res J. 1992;29(2):253–66.CrossRef
24.
go back to reference Sockolow P, et al. Impact of homecare electronic health record on timeliness of clinical documentation, reimbursement, and patient outcomes. Appl Clin Inform. 2014;5(02):445–62.PubMedPubMedCentralCrossRef Sockolow P, et al. Impact of homecare electronic health record on timeliness of clinical documentation, reimbursement, and patient outcomes. Appl Clin Inform. 2014;5(02):445–62.PubMedPubMedCentralCrossRef
25.
go back to reference Mac McCullough J, et al. Electronic health information exchange in underserved settings: examining initiatives in small physician practices & community health centers. BMC Health Serv Res. 2014;14(1):415.PubMedCrossRef Mac McCullough J, et al. Electronic health information exchange in underserved settings: examining initiatives in small physician practices & community health centers. BMC Health Serv Res. 2014;14(1):415.PubMedCrossRef
26.
go back to reference Jones EB, Furukawa MF. Adoption and use of electronic health records among federally qualified health centers grew substantially during 2010–12. Health Aff. 2014;33(7):1254–61.CrossRef Jones EB, Furukawa MF. Adoption and use of electronic health records among federally qualified health centers grew substantially during 2010–12. Health Aff. 2014;33(7):1254–61.CrossRef
27.
go back to reference Avey JB, et al. Impact of positive psychological capital on employee well-being over time. J Occup Health Psychol. 2010;15(1):17.PubMedCrossRef Avey JB, et al. Impact of positive psychological capital on employee well-being over time. J Occup Health Psychol. 2010;15(1):17.PubMedCrossRef
28.
go back to reference Avey JB, Wernsing TS, Luthans F. Can positive employees help positive organizational change? Impact of psychological capital and emotions on relevant attitudes and behaviors. J Appl Behav Sci. 2008;44(1):48–70.CrossRef Avey JB, Wernsing TS, Luthans F. Can positive employees help positive organizational change? Impact of psychological capital and emotions on relevant attitudes and behaviors. J Appl Behav Sci. 2008;44(1):48–70.CrossRef
30.
go back to reference Olson K, et al. Organizational strategies to reduce physician burnout and improve professional fulfillment. Curr Probl Pediatr Adolesc Health Care. 2019;49:100664.PubMedCrossRef Olson K, et al. Organizational strategies to reduce physician burnout and improve professional fulfillment. Curr Probl Pediatr Adolesc Health Care. 2019;49:100664.PubMedCrossRef
31.
go back to reference Skillman M, et al. Physician engagement strategies in care coordination: findings from the centers for Medicare & Medicaid Services’ health care innovation awards program. Health Serv Res. 2017;52(1):291–312.PubMedCrossRef Skillman M, et al. Physician engagement strategies in care coordination: findings from the centers for Medicare & Medicaid Services’ health care innovation awards program. Health Serv Res. 2017;52(1):291–312.PubMedCrossRef
32.
go back to reference Udwin M. Cultivating a great physician champion. Health Manag Technol. 2015;36(10):24.PubMed Udwin M. Cultivating a great physician champion. Health Manag Technol. 2015;36(10):24.PubMed
33.
go back to reference Spaulding A, Gamm L, Menser T. Physician engagement: strategic considerations among leaders at a major health system. Hosp Top. 2014;92(3):66–73.PubMedCrossRef Spaulding A, Gamm L, Menser T. Physician engagement: strategic considerations among leaders at a major health system. Hosp Top. 2014;92(3):66–73.PubMedCrossRef
34.
go back to reference Williams ES, et al. The relationship of organizational culture, stress, satisfaction, and burnout with physician-reported error and suboptimal patient care: results from the MEMO study. Health Care Manag Rev. 2007;32(3):203–12.CrossRef Williams ES, et al. The relationship of organizational culture, stress, satisfaction, and burnout with physician-reported error and suboptimal patient care: results from the MEMO study. Health Care Manag Rev. 2007;32(3):203–12.CrossRef
35.
go back to reference Fischer G. Meta-design: empowering all stakeholder as codesigners. In: Handbook of design in educational technology, vol. 135; 2013. Fischer G. Meta-design: empowering all stakeholder as codesigners. In: Handbook of design in educational technology, vol. 135; 2013.
36.
go back to reference Leslie H, et al. Engaging clinicians in clinical content: herding cats or piece of cake? Stud Health Technol Inform. 2009;150:125–9.PubMed Leslie H, et al. Engaging clinicians in clinical content: herding cats or piece of cake? Stud Health Technol Inform. 2009;150:125–9.PubMed
37.
go back to reference Farley HL, et al. Quality and safety implications of emergency department information systems. Ann Emerg Med. 2013;62(4):399–407.PubMedCrossRef Farley HL, et al. Quality and safety implications of emergency department information systems. Ann Emerg Med. 2013;62(4):399–407.PubMedCrossRef
39.
go back to reference Korner M, Ehrhardt H, Steger AK. Designing an interprofessional training program for shared decision making. J Interprof Care. 2013;27(2):146–54.PubMedCrossRef Korner M, Ehrhardt H, Steger AK. Designing an interprofessional training program for shared decision making. J Interprof Care. 2013;27(2):146–54.PubMedCrossRef
40.
go back to reference Christensen B, Ellingsen G. Evaluating model-driven development for large-scale EHRs through the openEHR approach. Int J Med Inform. 2016;89:43–54.PubMedCrossRef Christensen B, Ellingsen G. Evaluating model-driven development for large-scale EHRs through the openEHR approach. Int J Med Inform. 2016;89:43–54.PubMedCrossRef
41.
go back to reference Chokshi S, et al. User-centered development of a behavioral economics inspired electronic health record clinical decision support module. Stud Health Technol Inform. 2019;264:1155–8.PubMed Chokshi S, et al. User-centered development of a behavioral economics inspired electronic health record clinical decision support module. Stud Health Technol Inform. 2019;264:1155–8.PubMed
42.
go back to reference Rizvi RF, et al. Usability evaluation of an EHR’s clinical notes Interface from the perspective of attending and resident physicians: an exploratory study. Stud Health Technol Inform. 2017;245:1128–32.PubMed Rizvi RF, et al. Usability evaluation of an EHR’s clinical notes Interface from the perspective of attending and resident physicians: an exploratory study. Stud Health Technol Inform. 2017;245:1128–32.PubMed
43.
go back to reference Margalit RS, et al. Electronic medical record use and physician-patient communication: an observational study of Israeli primary care encounters. Patient Educ Couns. 2006;61(1):134–41.PubMedCrossRef Margalit RS, et al. Electronic medical record use and physician-patient communication: an observational study of Israeli primary care encounters. Patient Educ Couns. 2006;61(1):134–41.PubMedCrossRef
44.
go back to reference Kazmi Z. Effects of exam room EHR use on doctor-patient communication: a systematic literature review. Inform Prim Care. 2013;21(1):30–9.PubMedCrossRef Kazmi Z. Effects of exam room EHR use on doctor-patient communication: a systematic literature review. Inform Prim Care. 2013;21(1):30–9.PubMedCrossRef
45.
go back to reference Montague E, Asan O. Physician interactions with electronic health Records in Primary Care. Health Syst (Basingstoke). 2012;1(2):96–103.CrossRef Montague E, Asan O. Physician interactions with electronic health Records in Primary Care. Health Syst (Basingstoke). 2012;1(2):96–103.CrossRef
46.
go back to reference Street RL Jr, et al. Provider interaction with the electronic health record: the effects on patient-centered communication in medical encounters. Patient Educ Couns. 2014;96(3):315–9.PubMedPubMedCentralCrossRef Street RL Jr, et al. Provider interaction with the electronic health record: the effects on patient-centered communication in medical encounters. Patient Educ Couns. 2014;96(3):315–9.PubMedPubMedCentralCrossRef
47.
go back to reference Newman W, Button G, Cairns P. Pauses in doctor-patient conversation during computer use: the design significance of their durations and accompanying topic changes. Int J Human-Computer Stud. 2010;68(6):398–409.CrossRef Newman W, Button G, Cairns P. Pauses in doctor-patient conversation during computer use: the design significance of their durations and accompanying topic changes. Int J Human-Computer Stud. 2010;68(6):398–409.CrossRef
48.
go back to reference Warshawsky SS, et al. Physician use of a computerized medical record system during the patient encounter: a descriptive study. Comput Methods Prog Biomed. 1994;43(3–4):269–73.CrossRef Warshawsky SS, et al. Physician use of a computerized medical record system during the patient encounter: a descriptive study. Comput Methods Prog Biomed. 1994;43(3–4):269–73.CrossRef
Metadata
Title
A qualitative study of physician perspectives on adaptation to electronic health records
Authors
Cynthia J. Sieck
Nicole Pearl
Tiffani J. Bright
Po-Yin Yen
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Medical Informatics and Decision Making / Issue 1/2020
Electronic ISSN: 1472-6947
DOI
https://doi.org/10.1186/s12911-020-1030-6

Other articles of this Issue 1/2020

BMC Medical Informatics and Decision Making 1/2020 Go to the issue