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Physician experience with the Epic electronic health record (EHR) system: longitudinal findings from an emergency department implementation
Canadian Journal of Emergency Medicine ( IF 2.4 ) Pub Date : 2022-08-25 , DOI: 10.1007/s43678-022-00354-5
Courtney Price 1 , Edmund S H Kwok 1, 2 , Warren J Cheung 1, 2 , Venkatesh Thiruganasambandamoorthy 1, 2 , Glenda Clapham 1 , Marie-Joe Nemnom 3 , Samantha Calder-Sprackman 1, 4
Affiliation  

Objectives

In June 2019, The Ottawa Hospital launched the Epic electronic health record system, which transitioned all departments from a primarily paper-based system to an electronic system using a 1-day “big bang” approach. We sought to evaluate emergency physicians’ satisfaction with system implementation and perception of its impact on clinical practice in an academic emergency department (ED) setting.

Methods

Four electronic surveys were distributed to staff during pre-implementation (1-month prior [May 2019]) and post-implementation (1-month [July 2019], 9-month [March 2020], and 20-month [February 2021]) time periods. 5-point Likert scales were used to rate agreement with statements. Responses were compared using the Cochran–Mantel–Haenszel trend test to assess for significant differences.

Results

Response rates were consistent, ranging between 41 and 51%, with the exception of +9 months which was 27%. The majority of respondents were staff, working 8–15 shifts/month, with ≤ 10 years in practice. General satisfaction and confidence improved substantially from pre-implementation to 20 months post-implementation. Personalization sessions were perceived as not effective and lacking in quality, particularly immediately after Epic launch. Although clinical workflow tasks got easier, there were sustained challenges in efficiency and patient flow, including number of patients seen/hour, time spent after shift-end, and time spent on post-shift documentation.

Conclusions

Although satisfaction and system confidence improved over time, there were sustained difficulties in overall efficiency long after implementation, with opportunities for future optimization. Training was lacking in terms of relevance to emergency physician workflow. These factors should be considered in future electronic health record implementations in ED settings.



中文翻译:

Epic 电子健康记录 (EHR) 系统的医师经验:急诊科实施的纵向发现

目标

2019 年 6 月,渥太华医院推出了 Epic 电子健康记录系统,该系统使用 1 天的“大爆炸”方法将所有科室从主要基于纸质的系统转变为电子系统。我们试图评估急诊医师对系统实施的满意度以及对其在学术急诊科 (ED) 环境中对临床实践影响的看法。

方法

在实施前(1 个月前 [2019 年 5 月])和实施后(1 个月 [2019 年 7 月]、9 个月 [2020 年 3 月]和 20 个月 [2021 年 2 月])向员工分发了四份电子调查) 时间段。5 点李克特量表用于评估与陈述的一致性。使用 Cochran-Mantel-Haenszel 趋势检验比较响应以评估显着差异。

结果

反应率是一致的,介于 41% 和 51% 之间,除了 +9 个月为 27% 之外。大多数受访者是员工,每月轮班工作 8-15 班,实践年限≤10 年。从实施前到实施后 20 个月,总体满意度和信心显着提高。个性化会议被认为无效且缺乏质量,尤其是在 Epic 发布后。尽管临床工作流程任务变得更加容易,但在效率和患者流量方面仍存在持续挑战,包括每小时看到的患者数量、轮班结束后花费的时间以及轮班后文档所花费的时间。

结论

尽管满意度和系统信心随着时间的推移而提高,但在实施很久之后,整体效率仍然存在持续困难,未来还有优化的机会。缺乏与急诊医师工作流程相关的培训。在 ED 环境中的未来电子健康记录实施中应考虑这些因素。

更新日期:2022-08-25
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