Improving the Use of Electronic Medical Records in Primary Health Care: A Systematic Review and Meta-Analysis

Electronic Medical Records were first introduced in the 1970s to organize patient information, improve coordination of care, and improve communication. The purpose of this systematic review was to identify interventions aimed at improving EMR use in primary health care settings. Of 2,098 identified studies twelve were included in the review. Results showed that interventions focused on the use of EMR functions were five times more likely to show improvements in EMR use compared to controls. Interventions focused on data quality were five and a half times more likely to show improvements in EMR use compared to controls. Individuals in primary health care settings aiming to improve EMR use would benefit from implementing interventions focused on EMR feature add-ons, and provisions of educational materials, or financial incentives targeted at improving the use of EMR functions and data quality

Electronic Medical Records in Acute Care Hospitals: Correlates, Efficiency, and Quality

The purpose of this dissertation is to examine the organizational and environmental correlates of hospital EMR use and to examine the relationship between hospital EMR use and performance. Using a theoretical framework that combines resource dependence theory with Donabedian\u27s structure, process, outcome model, a conceptual model is created. To test the hypotheses of this model, logistic regression and Data Envelopment Analysis (DEA) are used. The data included in this analysis come from the AHA, HIMSS, CMS, ARF, and HQA. In the analysis of hospitals correlates of EMR use, three hypotheses were supported, and one was partially supported. Hospital system affiliation, bed size, and environmental uncertainty were found to be positively associated with hospital EMR use. Hospital rurality was found to be associated with EMR use for all categories except one; at every other level of rurality, as the hospital moves on a continuum from least rural to most urban, the likelihood of hospital EMR use also increases. Hospital EMR use was not found to be associated with teaching status, environmental munificence, competition, operating margin, ownership, or public payer mix. In the hospital performance analyses, one hypothesis was supported, and one was partially supported. Regarding quality, hospitals with EMRs were found to provide higher quality than those without EMRs. In efficiency performance, only small hospitals with EMRs were found to be more efficient than hospitals without EMRs. No support was found that hospitals with EMRs improve their efficiency over time more than hospitals without EMRs. Hospital EMR use does vary by certain organizational and environmental characteristics. For this reason, hospitals and policy makers must take action that enables and encourages all hospitals to implement and use EMRs because some hospitals do not have the motivation or resources to begin using EMRs on their own. Hospital EMR use is positively associated with high quality care, thus justifying the practice. Hospital efficiency was not found to be associated with EMR use in medium or large hospitals, but it was found to be associated with EMR use in small hospitals. Interestingly, larger hospitals are more likely to use EMRs than small hospitals. It is possible that the efficiency gains of EMR use in hospitals will not be realized until a standardized, fully interoperable system is developed, allowing health care provides to quickly and easily share the medical charts of their patients

Are We Putting the Cart Before the Horse? A Microcosm of Intended and Unintended Outcomes of Electronic Medical Record Implementation

Leaders in health care are calling for the implementation of electronic medical records (EMR) systems to help alleviate high costs of care delivery, high error rates, and uneven access to care. However, many of these leaders seem to be overlooking unintended outcomes of EMR implementation. Specifically, they may be overlooking the critical role physician beliefs and relationships play in the use of EMRs and in generating both intended and unintended outcomes. We studied a microcosm of the health care system through a qualitative field study examining EMR use in four clinics operating within a multi-specialty medical organization. We found that beliefs held by physicians about medical practice and the patterns of relationships in clinics influence EMR use behaviors in both expected and unexpected ways. Our contribution is to call attention to unintended outcomes of EMR implementation and to suggest that EMRs can be used as artifacts for learning

Medical Specialists' Perspectives on the Influence of Electronic Medical Record Use on the Quality of Hospital Care:Semistructured Interview Study

Objective: The aim of this study was to examine how, and by which aspects, the relationship between EMR use and the quality of care in hospitals is influenced according to medical specialists. Methods: To answer this question, a qualitative study was conducted in the period of August-October 2018. Semistructured interviews of around 90 min were conducted with 11 medical specialists from 11 different Dutch hospitals. For analysis of the answers, we used a previously published taxonomy of factors that can influence the use of EMRs. Results: The professional experience of the participating medical specialists varied between 5 and 27 years. Using the previously published taxonomy, these medical specialists considered technical barriers the most significant for EMR use. The suboptimal change processes surrounding implementation were also perceived as a major barrier. A final major problem is related to the categories “social” (their relationships with the patients and fellow care providers), “psychological” (based on their personal issues, knowledge, and perceptions), and “time” (the time required to select, implement, and learn how to use EMR systems and subsequently enter data into the system). However, the medical specialists also identified potential technical facilitators, particularly in the assured availability of information to all health care professionals involved in the care of a patient. They see promise in using EMRs for medical decision support to improve the quality of care but consider these possibilities currently lacking. Conclusions: The 11 medical specialists shared positive experiences with EMR use when comparing it to formerly used paper records. The fact that involved health care professionals can access patient data at any time they need is considered important. However, in practice, potential quality improvement lags as long as decision support cannot be applied because of the lack of a fully coded patient record

Identifying contributors to disparities in patient access of online medical records: Examining the role of clinician encouragement

OBJECTIVE: The aim of this study was to understand the influence of clinician encouragement and sociodemographic factors on whether patients access online electronic medical records (EMR). MATERIALS AND METHODS: We analyzed 3279 responses from the Health Information National Trends Survey 5 cycle 4 survey, a cross-sectional, nationally representative survey administered by the National Cancer Institute. Frequencies and weighted proportions were calculated to compare clinical encouragement and access to their online EMR. Using multivariate logistic regression, we identified factors associated with online EMR use and clinician encouragement. RESULTS: In 2020, an estimated 42% of US adults accessed their online EMR and 51% were encouraged by clinicians to access their online EMR. In multivariate regression, respondents who accessed EMR were more likely to have received clinician encouragement (odds ratio [OR], 10.3; 95% confidence interval [CI], 7.7-14.0), college education or higher (OR, 1.9; 95% CI, 1.4-2.7), history of cancer (OR, 1.5; 95% CI, 1.0-2.3), and history of chronic disease (OR, 2.3; 95% CI, 1.7-3.2). Male and Hispanic respondents were less likely to have accessed EMR than female and non-Hispanic White respondents (OR, 0.6; 95% CI, 0.5-0.8, and OR, 0.5; 95% CI, 0.3-0.8, respectively). Respondents receiving encouragement from clinicians were more likely to be female (OR, 1.7; 95% CI, 1.3-2.3), have college education (OR, 1.5; 95% CI, 1.1-2.0), history of cancer (OR, 1.8; 95% CI, 1.3-2.5), and greater income levels (OR, 1.8-3.6). DISCUSSION: Clinician encouragement of patient EMR use is strongly associated with patients accessing EMR, and there are disparities in who receives clinician encouragement related to education, income, sex, and ethnicity. CONCLUSIONS: Clinicians have an important role to ensure that all patients benefit from online EMR use

Factors Influencing Patients’ Perceptions toward Electronic Medical Record (EMR) Use: A Conceptual Model

Despite the rapid technological advancements in the last decade, the adoption of electronic medical record (EMR) systems by hospitals and healthcare providers are far less than expected (Ford, Menachemi, and Phillips, 2006; Hsiao, Hing, Socey, and Cai, 2010). Although a large number of previous studies focused on the adoption and use of EMR systems from the healthcare professionals’ perspectives, there is little research that examined this issue from the perspectives of patients. This study proposes a conceptual model that incorporates users’ characteristics, their personality traits, their perceptions on privacy and security, social influence, and a number of external factors, which influence patients’ perceptions toward EMR use. The proposed research model provides additional insights to the technology adoption and EMR adoption research

Linking electronic medical records use to physicians’ performance:a contextual analysis

Electronic Medical Records (EMR) studies have broadly tested EMR use and outcomes, producing mixed and inconclusive results. This study carefully considers the healthcare delivery context and examines relevant mediating variables. We consider key characteristics of: 1) interdependence in healthcare delivery processes, 2) physician autonomy, and 3) the trend of hospital employment of physicians, and draw on theoretical perspectives in coordination, shared values, and agency to explain how the use of EMR can improve physicians’ performance. In order to examine the effects of physician employment on work practices in the hospital, we collected 583 data points from 302 hospitals in 47 states in the USA to test two models; one for employed and another for non-employed physicians. Results show that information sharing and shared values among healthcare delivery professionals fully mediate the relationship between EMR use and physicians’ performance. Next, physician employment determines which mediating variable constitutes the pathway from EMR use to physicians’ performance. Finally, we highlight the impact of shared values between the hospital and physicians in enhancing information sharing and physicians’ performance, extending studies of these behaviors among network partners in industrial settings. Overall our study shows that EMR use should be complemented by processual (information sharing), social (shared values) and structural (physician employment) mechanisms to yield positive effects on physicians’ performance

Patient perceptions of electronic medical records use and ratings of care quality

Purpose: Despite considerable potential for improving health care quality, adoption of new technologies, such as electronic medical records (EMRs), requires prudence, to ensure that such tools are designed, implemented, and used meaningfully to facilitate patient-centered communication and care processes, and better health outcomes. The association between patients’ perceptions of health care provider use of EMRs and health care quality ratings was assessed.\ud Method: Data from two iterations of the Health Information National Trends Survey, fielded in 2011 and 2012, were pooled for these analyses. The data were collected via mailed questionnaire, using a nationally representative listing of home addresses as the sampling frame (n=7,390). All data were weighted to provide representative estimates of quality of care ratings and physician use of EMR, in the adult US population. Descriptive statistics, t-tests, and multivariable linear regression analyses were conducted.\ud Results: EMR use was reported significantly more frequently by females, younger age groups, non-Hispanic whites, and those with higher education, higher incomes, health insurance, and a usual source of health care. Respondents who reported physician use of EMRs had significantly higher ratings of care quality (Beta=4.83, standard error [SE]=1.7, P<0.01), controlling for sociodemographic characteristics, usual source of health care, and health insurance status.\ud Conclusion: Nationally representative data suggest that patients’ perceptions of EMR use are associated with their perceptions of the quality of the health care they receive