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      A Qualitative Analysis of the Impact of Electronic Health Records (EHR) on Healthcare Quality and Safety: Clinicians’ Lived Experiences

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          Abstract

          Purpose:

          There have been mixed findings of clinicians’ perceptions of Electronic Health Record (EHR). This study aims to explore the lived experiences of clinicians, to assess the role of EHR in improving the quality and safety of healthcare.

          Basic Procedures:

          A qualitative study design was used. We collected the opinions from different groups of clinicians (physicians, hospitalists, nurse practitioners, nurses, and patient safety officers) using semi-structured interviews. Organizations represented were trauma hospitals, academic medical centers, medical clinics, home health centers, and small hospitals.

          Main findings:

          Our study found clinicians’ ambivalent assessments toward EHR, which confirms extant literature. We compared the responses by job roles and found that nurses were positive about improving efficiency with EHR while others regarded EHR as time-consuming. While many underscored the importance of EHR in avoiding medical errors by improving data accessibility, nurses had concerns regarding data accuracy. Interoperability appeared to be a concern given limited system integration.

          Principal conclusions:

          Lived experiences of clinicians further tease out the mixed views about the effectiveness of EHR and highlight the challenges in EHR implementation. Redesigning the EHR and improving its implementation process may be potential solutions to increase its effectiveness.

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          Most cited references17

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          Electronic health records in ambulatory care--a national survey of physicians.

          Electronic health records have the potential to improve the delivery of health care services. However, in the United States, physicians have been slow to adopt such systems. This study assessed physicians' adoption of outpatient electronic health records, their satisfaction with such systems, the perceived effect of the systems on the quality of care, and the perceived barriers to adoption. In late 2007 and early 2008, we conducted a national survey of 2758 physicians, which represented a response rate of 62%. Using a definition for electronic health records that was based on expert consensus, we determined the proportion of physicians who were using such records in an office setting and the relationship between adoption and the characteristics of individual physicians and their practices. Four percent of physicians reported having an extensive, fully functional electronic-records system, and 13% reported having a basic system. In multivariate analyses, primary care physicians and those practicing in large groups, in hospitals or medical centers, and in the western region of the United States were more likely to use electronic health records. Physicians reported positive effects of these systems on several dimensions of quality of care and high levels of satisfaction. Financial barriers were viewed as having the greatest effect on decisions about the adoption of electronic health records. Physicians who use electronic health records believe such systems improve the quality of care and are generally satisfied with the systems. However, as of early 2008, electronic systems had been adopted by only a small minority of U.S. physicians, who may differ from later adopters of these systems. 2008 Massachusetts Medical Society
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            Electronic health record adoption in US hospitals: the emergence of a digital “advanced use” divide

            While most hospitals have adopted electronic health records (EHRs), we know little about whether hospitals use EHRs in advanced ways that are critical to improving outcomes, and whether hospitals with fewer resources – small, rural, safety-net – are keeping up. Using 2008–2015 American Hospital Association Information Technology Supplement survey data, we measured “basic” and “comprehensive” EHR adoption among hospitals to provide the latest national numbers. We then used new supplement questions to assess advanced use of EHRs and EHR data for performance measurement and patient engagement functions. To assess a digital “advanced use” divide, we ran logistic regression models to identify hospital characteristics associated with high adoption in each advanced use domain. We found that 80.5% of hospitals adopted at least a basic EHR system, a 5.3 percentage point increase from 2014. Only 37.5% of hospitals adopted at least 8 (of 10) EHR data for performance measurement functions, and 41.7% of hospitals adopted at least 8 (of 10) patient engagement functions. Critical access hospitals were less likely to have adopted at least 8 performance measurement functions (odds ratio [OR] = 0.58; P  < .001) and at least 8 patient engagement functions (OR = 0.68; P  = 0.02). While the Health Information Technology for Economic and Clinical Health Act resulted in widespread hospital EHR adoption, use of advanced EHR functions lags and a digital divide appears to be emerging, with critical-access hospitals in particular lagging behind. This is concerning, because EHR-enabled performance measurement and patient engagement are key contributors to improving hospital performance. Hospital EHR adoption is widespread and many hospitals are using EHRs to support performance measurement and patient engagement. However, this is not happening across all hospitals.
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              The Digitization of Patient Care: A Review of the Effects of Electronic Health Records on Health Care Quality and Utilization

              Electronic health records (EHRs) adoption has become nearly universal during the past decade. Academic research into the effects of EHRs has examined factors influencing adoption, clinical care benefits, financial and cost implications, and more. We provide an interdisciplinary overview and synthesis of this literature, drawing on work in public and population health, informatics, medicine, management information systems, and economics. We then chart paths forward for policy, practice, and research.
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                Author and article information

                Journal
                Health Serv Insights
                Health Serv Insights
                HIS
                sphis
                Health Services Insights
                SAGE Publications (Sage UK: London, England )
                1178-6329
                3 March 2022
                2022
                : 15
                : 11786329211070722
                Affiliations
                [1 ]Department of Healthcare Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV, USA
                [2 ]Department of Management, Entrepreneurship, and Technology, Lee Business School, University of Nevada Las Vegas, NV, USA
                Author notes
                [*]Soumya Upadhyay, Department of Healthcare Administration and Policy, School of Public Health, University of Nevada Las Vegas, 4505 S Maryland Pkwy, Las Vegas, NV, 89154 USA. Email: Soumya.upadhyay@ 123456unlv.edu
                Author information
                https://orcid.org/0000-0002-4651-0925
                Article
                10.1177_11786329211070722
                10.1177/11786329211070722
                8902175
                35273449
                a4467d82-a333-4322-ba38-554ff54d0ecd
                © The Author(s) 2022

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 5 August 2021
                : 13 December 2021
                Funding
                Funded by: UNLV University Libraries, ;
                Categories
                Original Research
                Custom metadata
                January-December 2022
                ts1

                electronic health record,ehr,healthcare quality,patient safety,semi-structured interview,ehr challenges

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