Providers perceptions
about impact of EHR
in a community EHR project
Armine Lulejian, MS, MPH, CHES
Sarah Shih, MPH
Farzad Mostashari, MD, MSc
Primary Care Information Project
NYC DOHMH
Academy Health
June 2009
Primary Care Information Project
Progress to Date (May ‘09)
Mission
• Increase the quality of care in
medically underserved areas
through health information
technology (HIT)
Goals
• Extend EHRs that support
prevention to
2,500 Medicaid PCPs
Over 2 million patients
Live on EHR
• 1,247 providers
• 207 Practices
Evaluation Approach
Study Protocol
Study Question
What are provider perceptions and experience before and
after with the different features of EHRs?
Available Data
• Pre-EHR Provider surveys (baseline)
On-going
469 completed; representing 2 hospitals, 13
community health centers, 99 small practices
Response rate: 53%
• Pilot Post-EHR Provider survey
Validation study to inform post 6-month instrument
96 completed; representing 4 hospitals, 4 community
health centers, 38 small practices
Response rate: 62%
Content of Surveys
• Opinions about
Documentation
Task and workflow
Preventive care
Panel management
• Items related to
System quality
Information quality
System use
User satisfaction
• Computer technology, training and support
• Demographics
Respondent Demographics
Pre-EHR
Post-EHR
(Pilot)
Total # Completed Surveys**
369
96
Overall Response Rate
53%
62%
% MD/DO
74%
86%
Median # of patients seen per week**
144
120
Median Years in Practices
7
9
High Comfort Level with Computer Technology
-
52%
10 or more hours of training received on EHR
-
17%
Preliminary Provider Perceptions
(Cross-sectional, unmatched data)
General Impressions about EHR…
…improve ability to provide preventive care
48
36
…improve ability to make decisions about patient care
41
…improve access to patient information
66
48
…disrupt work flow
35
21
…generate too many alerts and reminders during patient visit
26
15
…decrease the amount of time talking with patients
36
21
…make patient visits longer or the provider work longer hours
to see the same number of patients
P o st-EHR
53
54
21
0
10
20
30
40
50
60
P re-EHR
% of Respondent "Com pletely" or "Generally" Agree
70
Preliminary Provider Perceptions
(Cross-sectional, unmatched data)
Documentation
55
Histories
73
62
Physical exams
75
60
Allergies
Billing (CPT and ICD9 Codes)
48
Keeping problem lists
61
70
45
0
80
50
% Respondents
Pre-EHR
% Very or Generally Satisfied*
Post-EHR
% Slightly Easier or Much Easier**
*Answer choices: Very Satisfied, Generally Satisfied, Somewhat Dissatisfied, Very Dissatisfied, Not Applicable
**Much More Difficult, Slightly More Difficult, No Change, Slightly Easier, Much Easier
***Respondents were asked check “NA/Don’t Know” if they never used the EHR for the task
100
Preliminary Provider Perceptions
(Cross-sectional, unmatched data)
Task Management
50
Writing Rx
71
Renewing Rx
58
62
45
Ordering labs
72
54
Reviewing labs
Assisting patient in
self-management activities
66
44
44
Communicating referrals
to sub-specialists
40
0
46
50
% Respondents
Pre-EHR
% Very or Generally Satisfied*
Post-EHR
% Slightly Easier or Much Easier**
*Answer choices: Very Satisfied, Generally Satisfied, Somewhat Dissatisfied, Very Dissatisfied, Not Applicable
**Much More Difficult, Slightly More Difficult, No Change, Slightly Easier, Much Easier
***Respondents were asked check “NA/Don’t Know” if they never used the EHR for the task
100
… the benefits of adopting an EHR will/have
outweigh/outweighed the challenges …
Pre
Post
60
50.6
50
44.8
40
Percent
33.8
30
22.9
20
10
14.6
9.5
11.5
6.3
4.3
1.7
0
Don't know
Completely agree
Generally agree
Generally
disagree
Completely
disagree
Conclusions & Future Directions
Conclusions
• EHRs are worth the effort (per providers)!
~ ¾ respondents feel that benefits outweigh costs
• EHRs impact tasks (some positive and some negative)
High overall performance with documentation
Less performance with some task management
Providers report spending longer hours working, and less
time with patients
Future Directions
• Stratifying of responses by provider type, practice type, etc.
• Match reports at provider and site level to understanding
trending
• Conduct interview/focus groups to understand some of the
results better
Questions? Comments?
Contact Info:
Armine Lulejian, MS, MPH, CHES
Primary Care Information Project
NYC DOHMH
161 William Street, 5th floor
New York, NY 10038
(212) 788-5680 tel.
alulejia@health.nyc.gov
Academy Health
June 2009