Journal of Medical Systems

, Volume 36, Issue 5, pp 3141–3149 | Cite as

Use and Satisfaction with Electronic Health Record by Primary Care Physicians in a Health District in Brazil

  • Alexandre Alcantara Holanda
  • Henrique Luis do Carmo e Sá
  • Anya Pimentel Gomes Fernandes Vieira
  • Ana Maria Fontenelle Catrib
Original Paper

Abstract

It is believed that Electronic Health Records (EHR) improve not only quality of care but also patient safety and health care savings. This seems to be true for developed countries but not necessarily in emerging economies. This paper examined the primary care physicians’ satisfaction with a specific EHR in a health district of a major city in Brazil and describes how they are using it as well as its specific functions. A cross-sectional questionnaire survey with all physicians from all Community Health Centers of the 6th health district of the City of Fortaleza that were using HER was conducted. From the 111 subjects (100%), a total of 99 physicians answered the survey (89% response rate). For overall satisfaction with the EHR, 2 (2%) were satisfied, 50 (50.5%) were satisfied in part and 47 (47.5%) were not satisfied. For the functionalities, a proportion of correct answers (PCA) and an index of functionality usage (IFU) were developed. PCA and IFU were significantly correlated (p < 0.001). Inverse and weak correlations were found between PCA and age (p < 0.001), years since medical school and years of work (p < 0.01). For usage (IFU), there was inverse correlation with “years working in Family Health Strategy” (p < 0.05). High IFU was associated with physicians who stated to use easily Internet and Email; who saw less patients per half-day; who were women (p < 0.05), younger (p < 0.05), in training (p < 0.05) and not satisfied with the EHR (p < 0.05).The use of EHR was associated with being young, female, still in training and seeing less than 16 patients per half-day. Structural issues (e.g. network and system support) seemed to be major barriers in this setting. Lack of classical functionalities such as problem list and clinical reminders could have contributed to exacerbate misperceptions about what EHRs can do in improving work processes and patient care.

Keywords

Medical records systems Computerized Primary health care Developing countries Ambulatory care Health services evaluation 

Notes

Acknowledgements

To the University of Fortaleza and those professional (medical doctors) who participated in this research.

Competing interests

The author(s) declare that they have no competing interests

Authors’ contributions

This manuscript is a result of the master dissertation of AAH, participating in all stages of this research, including, design of the study, data collection, data analysis and draft of the manuscript. The author AMFC was the main supervisor for this study, participating in the design of the study, critical analysis of the data and draft of the manuscript. APGFV and HLCS were co-supervisors of this study, giving support in the methodological approach, statistical analysis, critical review of the results and draft of the manuscript.

References

  1. 1.
    Chaudhry, B., Wang, J., Wu, S., Maglione, M., Mojica, W., Roth, E., Morton, S. C., and Shekelle, P. G., Systematic review: Impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med 144(10):742–752, 2006.Google Scholar
  2. 2.
    DesRoches, C. M., Campbell, E. G., Rao, S. R., Donelan, G., Ferris, T. G., Jha, A., Kaushal, R., Levy, D. E., Rosenbaum, S., Shields, A. E., and Blumenthal, D., Electronic health records in ambulatory care–a national survey of physicians. N Engl J Med 359(1):50–60, 2008.CrossRefGoogle Scholar
  3. 3.
    Berner, E. S., Detmer, D. E., and Simborg, D., Will the wave finally break? A brief view of the adoption of electronic medical records in the United States. J Am Med Inform Assoc 12(1):3–7, 2005.CrossRefGoogle Scholar
  4. 4.
    Arnold S. L., Wieners W. W., Ball M. J., Bell B. L., Cheung N. T., Heidenreich G.: Electronic Health Records: A Global Perspective. A Work Product of the Healthcare Information and Management Systems Society Enterprise Systems Steering Committee and the Global Enterprise Task Force [report on the Internet]. 2008 Aug. Available from: http://www.himss.org/ASP/topics_News_item.asp?cid=66446&tid=10
  5. 5.
    Tomasi, E., Facchini, L. A., and Maia, M. F., Health information technology in primary health care in developing countries: A literature review. Bull World Health Organ 82(11):867–874, 2004.Google Scholar
  6. 6.
    Murff, H. J., and Kannry, J., Physician satisfaction with two order entry systems. J Am Med Inform Assoc 8(5):499–509, 2001.CrossRefGoogle Scholar
  7. 7.
    Dos Santos, N. R., The evolution of the Brazilian National Health System, strategic courses of action and strategies to understand these actions. Cien Saude Colet 12(2):429–435, 2007.CrossRefGoogle Scholar
  8. 8.
    Vianna, A. L. D., and Dal Poz, M. R., A reforma sanitária do sistema de saúde no Brasil e Programa de Saúde da Família. Physis: Revista de Saúde Coletiva 8(2):11–48, 2005.CrossRefGoogle Scholar
  9. 9.
    Sequist, T. D., Cullen, T., Hays, H., Taualii, M. M., Simon, S. R., and Bates, D. W., Implementation and use of an electronic health record within the Indian Health Service. J Am Med Inform Assoc 14(2):191–197, 2007.CrossRefGoogle Scholar
  10. 10.
    Pan American Health Organization/Minister of Health. Rede Interagencial de Informações Para a Saúde (RIPSA). Indicadores e Dados Básicos IDB-2007 [database on the Internet]. Brasília, 2008. Available from: http://tabnet.datasus.gov.br/cgi/tabcgi.exe?idb2007/e01.def
  11. 11.
    Regional Medical Council of the State of Ceará (CREMEC). Statistics Section. [database on the Internet]. Available from: http://www.portalmedico.org.br/novoportal/index5.asp
  12. 12.
    Tu, H. T., and O’malley, A. S., Exodus of male physicians from primary care drives shift to specialty practice. Track Rep 17:1–6, 2007.Google Scholar
  13. 13.
    Linder J. A., Schnipper J. L., Tsurikova R., Melnikas A. J., Volk L. A., Middleton B.: Barriers to electronic health record use during patient visits. AMIA Annu Symp Proc 2006:499–503.Google Scholar
  14. 14.
    Patterson, E. S., Nguyen, A. D., Halloran, J. P., and Asch, S. M., Human factors barriers to the effective use of ten HIV clinical reminders. J Am Med Inform Assoc 11(1):50–59, 2004.CrossRefGoogle Scholar
  15. 15.
    Starfield, B., Primary care: balancing health needs, services and technology. Oxford University Press, New York, p. 438 p, 1998.Google Scholar
  16. 16.
    Magalhaes, R., and Senna Mde, C., Local implementation of the Family Health Program in Brazil. Cad Saude Publica 22(12):2549–2559, 2006.CrossRefGoogle Scholar
  17. 17.
    Cherry, B. J., Ford, E. W., and Peterson, L. T., Experiences with electronic health records: Early adopters in long-term care facilities. Health Care Manage Rev. 36(3):265–274, 2011.CrossRefGoogle Scholar
  18. 18.
    Pfoh E. R., Abramson E., Zandieh S., Edwards A., Kaushal R. J. Satisfaction after the transition between electronic health record systems at six ambulatory practices Eval Clin Pract. 2011.Google Scholar
  19. 19.
    Top M., Gider O. Nurses’ Views on Electronic Medical Records (EMR) in Turkey: An analysis according to use, quality and user satisfaction J Med Syst. 2011.Google Scholar
  20. 20.
    Edsall, R. L., and Adler, K. G., User satisfaction with EHRs: report of a survey of 422 family physicians. Fam Pract Manag 15(2):25–32, 2008.Google Scholar
  21. 21.
    Adler, K. G., How to successfully navigate your EHR implementation. Fam Pract Manag 14(2):33–39, 2007.Google Scholar
  22. 22.
    Kuperman, G., and Bates, D. W., Standardized coding of the medical problem list. J Am Med Inform Assoc 1(5):414–415, 1994.CrossRefGoogle Scholar
  23. 23.
    Donaldson, S., and Grant-Vallone, E., Understanding self-report bias in organizational behavior research. J Bus Psychol 17(2):245–260, 2002 [serial on the Internet].CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Alexandre Alcantara Holanda
    • 1
  • Henrique Luis do Carmo e Sá
    • 1
  • Anya Pimentel Gomes Fernandes Vieira
    • 2
  • Ana Maria Fontenelle Catrib
    • 2
  1. 1.Universidade de Fortaleza School of MedicineFortalezaBrazil
  2. 2.Public Health Master ProgramUniversidade de FortalezaFortalezaBrazil

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