Journal of General Internal Medicine

, Volume 34, Issue 1, pp 132–136 | Cite as

Effect on VA Patient Satisfaction of Provider’s Use of an Integrated Viewer of Multiple Electronic Health Records

  • Aaron Legler
  • Megan Price
  • Megha Parikh
  • Jonathan R. Nebeker
  • Merry C. Ward
  • Linda Wedemeyer
  • Steven D. PizerEmail author
Original Research



To examine associations between patient perceptions that their provider was knowledgeable of their medical history and clinicians’ early adoption of an application that presents providers with an integrated longitudinal view of a patient’s electronic health records (EHR) from multiple healthcare systems.


This retrospective analysis utilizes provider audit logs from the Veterans Health Administration Joint Legacy Viewer (JLV) and patient responses to the Survey of Patient Healthcare Experiences Patient-Centered Medical Home (SHEP/PCMH) patient satisfaction survey (FY2016) to assess the relationship between the primary care provider being an early adopter of JLV and patient perception of the provider’s knowledge of their medical history. Multivariate logistic regression models were used to control for patient age, race, sex education, health status, duration of patient-provider relationship, and provider characteristics.


The study used responses from 203,903 patients to the SHEP-PCMH survey in FY2016 who received outpatient primary care services from 11,421 unique providers. Most (91%) clinicians had no JLV utilization in the 6 months prior to the studied patient visit. Controlling for patient demographics, length of the patient-provider relationship, and provider and facility characteristics, being an early adopter of the JLV system was associated with a 14% (adj OR 1.14, p < 0.000) increased odds that patients felt their provider was knowledgeable about their medical history. When evaluating the interaction between duration of patient-provider relationship and being an early adopter of JLV, a greater effect was seen with patient-provider relationships that were greater than 3 years (adj OR 1.23, p < 0.000), compared to those less than 3 years.


Increasing the interoperability of medical information systems has the potential to improve both patient care and patient experience of care. This study demonstrates that early adopters of an integrated view of electronic health records from multiple delivery systems are more likely to have their patients report that their clinician was knowledgeable of their medical history. With provider payments often linked to patient satisfaction performance metrics, investments in interoperability may be worthwhile.


electronic medical record (EMR) electronic health record (EHR) health information exchange (HIE) health information technology (HIT) interoperability patient satisfaction 



The authors wish to thank David Schmidt for helpful comments on prior versions of this work and for logistical assistance.

Funding Information

This research was supported by the VA Office of Health Informatics and by Grant Number PEC 16-001 from the VA Quality Enhancement Research Initiative (QUERI). Opinions and conclusions expressed are those of the authors and do not reflect the official position of the US Department of Veterans Affairs, the University of Utah, or Boston University.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.


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Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  • Aaron Legler
    • 1
  • Megan Price
    • 1
  • Megha Parikh
    • 1
  • Jonathan R. Nebeker
    • 2
    • 3
    • 4
  • Merry C. Ward
    • 4
  • Linda Wedemeyer
    • 4
  • Steven D. Pizer
    • 1
    • 5
    Email author
  1. 1.Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare SystemUS Department of Veterans AffairsBostonUSA
  2. 2.Department of MedicineUniversity of Utah School of MedicineSalt Lake CityUSA
  3. 3.Geriatric Research and Education Clinical Center, VA Salt Lake City Health Care SystemUS Department of Veterans AffairsSalt Lake CityUSA
  4. 4.Office of Health InformaticsUS Department of Veterans AffairsLos AngelesUSA
  5. 5.Department of Health Law, Policy, and Management Boston University School of Public HealthBostonUSA

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