Article Figures & Data
Figures
- Figure 1.
Study inclusion process. EHR, electronic health record.
Tables
Author Setting EHR Used Study Design Patients Description Physicians Description Gadd (2000) Single center, university based, Physical Medicine and Rehabilitation department, Pittsburgh, PA Epicare, commercial Pre/post implementation for physicians’ perceptions; only postimplementation for patients Patients surveyed 6 months after implementation of EHR Age 19 to 83 years (median, 45 years); 37% “unsophisticated” with computer use 165 surveys analyzed 5 faculty (2 women, 3 men); average age, 37 years Gadd (2001) Single center, university based, Physical Medicine and Rehabilitation, internal medicine, renal, pulmonary, geriatrics, ID, Pittsburgh, PA Epicare, commercial Physicians’ perception of patient satisfaction before and 6 months after EHR implementation No patients characteristics described 124 encounters analyzed 75 physicians (97%) before EHR implementation and 95 faculty (70%) after EHR implementation; average age, 40 years Garrison (2002) Single center, academic family medicine clinic, Midwest In-house developed Pre (2 years before EHR)/post Patients with hypertension, dyslipidemia Mean age, 64 years 56.5% women Analyzed 200 before and 304 after EHR implementation 33 (9 faculty, 24 residents) 2 nurse practitioners 3 years’ experience with EHR Hsu (2005) Single center, Kaiser Permanente, Portland, OR Epic systems Pre (2 months prior)/post (1 and 7 months after) Mean age, 55 years 64% women 32% with college degree 107 before EHR implementation; 81 and 125 after implementation 8 (out of 17 primary care physicians in internal medicine and family practice) Age not described Johnson (2005) Single center, Hospital-based pediatric teaching clinic Clictate, non commercial, developed by author Pre (historical)/post (1 year after EHR) survey Pediatric population (<18 months) for well child exams Parents surveyed 149 encounters before EHR implementation; 221 encounters after implementation Before implementation of EHR: 25% male, 44% PGY1 After implementation: 38% male, 21% PGY1 (both significantly different) Joos (2006) Single center Adult ambulatory primary care and urgent care clinic in an academic hospital; TN Unknown Cross-sectional Physicians’ perception of patient satisfaction Not described 46 (out of 70 physicians) 37% younger than 30 years of age 54% male Median of 5 years in practice Rouf (2006) VA system Primary care clinic NY VA system, non commercial Cross-sectional Group faculty: mean age, 72 years; 100% male Group residents: mean age, 69.5 years; 93.5% male 6 patients/physician (internist) 155 analyzed Faculty: 11 (out of 18); mean age, 42 years; 36% male; 6 years in practice Residents: 12 (out of 32); mean age, 30 years; 68% male; 2.2 years in practice EHR, electronic health record; ID, infectious disease; PGY1, postgraduate year 1; VA, Veterans Affairs.
Study Funding Population Independent Variable Dependent Variable Other Methodological Issues Gadd (2000) None specified Sampling method: non random, sequential Sample size: not justified Response rate: 82% EHR was in the exam room for more than 6 months prior to data collection Unsure how many physicians used it or how they did Survey for patient satisfaction attitudes, developed and validated Blinding of data collector: N/A Blinding of analyst: not specified Possible variable experience with EHR usage inside the room Potential confounders considered in analysis: patient age, gender, self-rated computer sophistication or computer use Gadd (2001) None specified Sampling method: nonrandom Sample size: not justified Response rate: 77% in pre- and in post- Time (preimplementation and postimplementation of EHR) Unsure how many physicians used EHR or how they did Physicians’ perception; instrument validated Blinding of data collector: N/A Blinding of analyst: not specified No confounders were considered in the analysis Postintervention data collection over 18 months period Garrison (2002) HRSA grant Sampling method: nonrandom for post-, random for pre- Sample size justified Clear eligibility criteria Comparison to a historical sample Response rate 64% in post- Time (pre/post) Describes if physicians used EHR inside room Questionnaire designed for this study, piloted, but no mention of validation Blinding of data collector or data analyst: not mentioned Addressed respondent bias Analyzed if associations with patients’ perception of physicians’ computer skills and patients’ personal use of computer No adjustments for confounders mentioned Hsu (2005) Garfield memorial fund Sampling method: nonrandom; PCP volunteers and their patients; convenience Sample size: not justified Eligibility criteria defined Patients’ response rate: 80% Physicians familiar with the system prior to the intervention Training happened between data collection times in post (100% physicians attended) Self-administered questionnaire, pre-tested; based on “Medical Outcomes Study” No mention of blinding in data collection or analysis Confounders considered in analysis: age, gender, self-reported health status, race/ethnicity, annual household income, education, previously seen the PCP Johnson (2005) Multiple* Sampling method: nonrandom in post- Eligibility defined Control: random selection, historical Sample size justified Response rate 92% (post) Use of EHR assessed after the encounter by physicians Questionnaire based on a tool developed by Wissow el al to assess satisfaction No mention of blinding of data collector or analyst Confounders considered in analysis: Physician sex and year of training, possible within physician correlations Joos (2006) No funding Sampling method: nonrandom, convenient Sample size not justified Response rate 66% (physicians) EHR already in place before this survey done No direct assessment of use of EHR, but general questions (not after each encounter) Survey built after qualitative section, tested for face validity No blinding for data collection or analysis Confounders considered in the analysis: gender, computer skill, message basket use and years of practice (but not for the outcome of interest) Rouf (2006) HRSA Eligibility specified Sampling method: nonrandom Sample size not justified Response rate 61% of attending and 38% of residents EHR already in place Questionnaires from Medical Outcomes Study–reviewed for face validity–and piloted No blinding Confounders considered in the analysis: done but not specified which ones * Funding from Robert Wood Johnson Foundation, Agency for Healthcare Research and Quality, Maternal and Child Health Bureau, Health Resources and Services Administration-Department of Health and Human Services, National Center for Injury Prevention and Control.
EHR, electronic health record; HRSA, Health Resources and Services Administration; PCP, primary care physician.
Author Outcome Results Authors’ Conclusion Our Interpretation Gadd (2000) 1 to 5 Likert scale (strongly disagree to strongly agree) General Satisfaction Scale 4.59 (±0.47); Physician Computer Use Scale 4.00 (±0.68)* Patients did not indicate a sense of loss of rapport with their physicians Neutral Gadd (2001) 1 to 5 Likert scale (highly detrimental to highly beneficial) Before implementation: mean score, 3.20 (±0.60) After implementation: mean score, 2.91(±0.85) P = .019 Physicians perceive EHR use had a detrimental impact on patient's satisfaction with quality of care and physician autonomy Negative Garrison (2002) Percentage of “excellent or very good” to “How would you rate the overall care you received?” Before implementation: 81% After implementation: 83.5% P= NS No difference in patient satisfaction after the introduction of point-of-care computers at the clinic Neutral Hsu (2005) Percentage of reporting “excellent satisfaction” 2 months before implementation: OR, 1 (reference) 1 month after implementation: OR, 1.64; 95% CI, 0.83–3.24 7 months after implementation: OR, 1.50; 95% CI, 1.01–2.22 The examination room computers seemed to have positive effects on physician-patient interactions Positive Johnson (2005) Percentage who report “strongly agree” to satisfaction with attention given by physician and medical care received Attention After implementation: OR, 0.89; 95% CI, 0.49 to 1.59, before implementation being the reference Medical care received After implementation: OR, 1.77; 95% CI, 0.97 to 3.25, before implementation being the reference The adoption of computer based documentation in a primary care pediatric clinic did not significantly affect parent satisfaction with the encounter Neutral Joos (2006) Percentage of response to “the new system has increased patient satisfaction” 31% agree 62% neutral 7% disagree Physicians did not know whether or not the use of EHR impacted patient satisfaction Neutral Rouf (2007) Percentage that “strongly agree” they were satisfied with overall relationship with physician Patients seeing residents: 50% Patients seeing faculty: 71%; P = .02 Patients seeing residents were more likely to report negative effect on the patient-physician interaction. However, only 8% of all patients reported that the computer interfered with their relationship with their doctor. Neutral * General Satisfaction Scale: 10 overall visit and patient satisfaction items; Physician Computer Use Scale: 5 computer-related satisfaction items.
EHR, electronic health record; OR, odds ratio.
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