Advertisement

Usability Challenges and Barriers in EHR Training of Primary Care Resident Physicians

  • Min Soon Kim
  • Martina A. Clarke
  • Jeffery L. Belden
  • Elaine Hinton
Part of the Lecture Notes in Computer Science book series (LNCS, volume 8529)

Abstract

Current EHRs require a large investment of resources for a user to reach a certain level of proficiency, which is a significant obstacle for new physicians who are not sufficiently trained by their medical schools. Beginning residents in primary care cope with a steep learning curve on EHR use due to EHRs with poor usability, which may lead to medical errors, and decreased quality of patient care. Identifying and addressing early barriers in the learning environment of residents while using an EHR can help improve overall capacity of the new physicians, and save costs for the organization. The goal of this study is to assess current usability challenges and barriers in EHR education and training program at the University of Missouri Health Care (UMHC).

Keywords

Electronic Medical Record Electronic Health Record Health Information Technology Computerize Physician Order Entry System Electronic Health Record Implementation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Schoen, C., et al.: On The Front Lines Of Care: Primary Care Doctors Office Systems, Experiences, And Views In Seven Countries. Health Affairs 25(6), w555–w571 (2006)Google Scholar
  2. 2.
    Hsiao, C.-J., Hing, E.: Use and characteristics of electronic health record systems among office-based physician practices: United States, 2001–2012. NCHS Data Brief 2012(111), 1–8Google Scholar
  3. 3.
    Scott, J.T., et al.: Kaiser Permanente’s experience of implementing an electronic medical record: A qualitative study. BMJ 331(7528), 6–1313 (2005)CrossRefGoogle Scholar
  4. 4.
    Koppel, R., et al.: Role of computerized physician order entry systems in facilitating medication errors. JAMA, 2005 293(10), 1197–1203 (2005)Google Scholar
  5. 5.
    Crabtree, B.F., et al.: Delivery of clinical preventive services in family medicine offices. Ann. Fam. Med. 3(5), 430–435 (2005)CrossRefGoogle Scholar
  6. 6.
    Ash, J.S., Berg, M., Coiera, E.: Some unintended consequences of information technology in health care: The nature of patient care information system-related errors. J. Am. Med. Inform. Assoc. 11(2), 104–112 (2004)CrossRefGoogle Scholar
  7. 7.
    Beuscart-Zéphir, M.C., et al.: The human factors engineering approach to biomedical informatics projects: State of the art, results, benefits and challenges. Yearbook of Medical Informatics, 109–127 (2007)Google Scholar
  8. 8.
    Standard ISO 9241: Ergonomic requirements for office work with visual display terminals (VDTs), part 11: Guidance on usability (1998b)Google Scholar
  9. 9.
    Edsall, R.L., Adler, K.G.: The 2012 EHR User Satisfaction Survey: Responses From 3,088 Family Physicians. Family Practice Management 19(6) (2012)Google Scholar
  10. 10.
    Hammoud, M.M., et al.: Opportunities and challenges in integrating electronic health records into undergraduate medical education: A national survey of clerkship directors. Teach. Learn. Med. 24(3), 219–224 (2012)CrossRefGoogle Scholar
  11. 11.
    Elliott, G.J., Jones, E., Barker, P.: A grounded theory approach to modelling learnability of hypermedia authoring tools. Interacting with Computers 14(5), 547–574 (2002)CrossRefGoogle Scholar
  12. 12.
    Terry, A.L., et al.: Implementing electronic health records: Key factors in primary care. Can. Fam. Physician. 54(5), 730–736 (2008)Google Scholar
  13. 13.
    Peled, J.U., et al.: Do electronic health records help or hinder medical education? PLoS. Med. 6(5), e1000069 (2009)Google Scholar
  14. 14.
    Kushniruk, A.W., et al.: Exploring the relationship between training and usability: A study of the impact of usability testing on improving training and system deployment. Stud. Health Technol. Inform. 143, 277–283 (2009)Google Scholar
  15. 15.
    2012 Annual Report. University of Missouri Health Care, Columbia, MOGoogle Scholar
  16. 16.
    MU 2011 Annual Report. MU Healthcare 2011 http://www.mydigitalpublication.com/publication/?i=106794 (cited April 15, 2012)
  17. 17.
    University of Missouri Health Care Achieves Highest Level of Electronic Medical Record Adoption, in University of Missouri Health Care News Releases, Columbia, MOGoogle Scholar
  18. 18.
    U.S. EMR Adoption Model Trends (2011)Google Scholar
  19. 19.
    Stage 7 Hospitals (2012), http://www.himssanalytics.org/emram/stage7Hospitals.aspx (cited October 2012)
  20. 20.
    EHR IMPLEMENTATIONSURVEY: Proactive Consideration and Planning Lead to Successful EHR Implementation. HIMSS, Chicago, IL (2013)Google Scholar
  21. 21.
    Blumenthal, D., Tavenner, M.: The “meaningful use” regulation for electronic health records. New England Journal of Medicine 363(6), 501–504 (2010)CrossRefGoogle Scholar
  22. 22.
    Blumenthal, D.: Launching HITECH. New England Journal of Medicine 362(5), 382–385 (2010)CrossRefGoogle Scholar
  23. 23.
    Chaudhry, B., et al.: Systematic review: Impact of health information technology on quality, efficiency, and costs of medical care. Ann. Intern. Med. 144(10), 742–752 (2006)CrossRefGoogle Scholar
  24. 24.
    Bates, D.W., Gawande, A.A.: Improving safety with information technology. New England Journal of Medicine 348(25), 2526–2534 (2003)CrossRefGoogle Scholar
  25. 25.
    Chaudhry, B., et al.: Systematic review: Impact of health information technology on quality, efficiency, and costs of medical care. Annals of Internal Medicine 144(10), 742–752 (2006)CrossRefGoogle Scholar
  26. 26.
    Corrigan, J.M., Greiner, A., Erickson, S.M.: Fostering Rapid Advances in Health Care: Learning from System Demonstrations (2002)Google Scholar
  27. 27.
    Donaldson, M.S.: Primary care: America’s health in a new era1996. National Academies Press (1996)Google Scholar
  28. 28.
    Kohn, L.T.: The Institute of Medicine report on medical error: Overview and implications for pharmacy. Am. J. Health Syst. Pharm. 58(1), 63–66 (2001)Google Scholar
  29. 29.
    Maguire, M.: Methods to support human-centred design. International Journal of Human-Computer Studies 55(4), 587–634 (2001)CrossRefzbMATHGoogle Scholar
  30. 30.
    Goldzweig, C.L., et al.: Costs and benefits of health information technology: New trends from the literature. Health Affairs 28(2), w282–w293 (2009)Google Scholar
  31. 31.
    Hillestad, R., et al.: Can electronic medical record systems transform health care? Potential health benefits, savings, and costs. Health Affairs 24(5), 1103–1117 (2005)CrossRefGoogle Scholar
  32. 32.
    Holroyd-Leduc, J.M., et al.: The impact of the electronic medical record on structure, process, and outcomes within primary care: A systematic review of the evidence. Journal of the American Medical Informatics Association 18(6), 732–737 (2011)CrossRefGoogle Scholar
  33. 33.
    Steele, E.: EHR implementation: who benefits, who pays? Health ManagTechnol 27(7), 43–44 (2006)Google Scholar
  34. 34.
    Han, Y.Y., et al.: Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system. Pediatrics 116(6), 1506–1512 (2005)CrossRefGoogle Scholar
  35. 35.
    Tang, P.C., Patel, V.L.: Major issues in user interface design for health professional workstations: summary and recommendations. Int. J. Biomed. Comput. 34(1-4), 139–148 (1994)CrossRefGoogle Scholar
  36. 36.
    Grumbach, K., Bodenheimer, T.: A Primary Care Home for Americans. JAMA: The journal of the American Medical Association 288(7), 889–893 (2002)CrossRefGoogle Scholar
  37. 37.
    Morrison, I., Smith, R.: Hamster health care. BMJ 321(7276), 1541–1542 (2000)CrossRefGoogle Scholar
  38. 38.
    Anderson, L.K., Stafford, C.J.: The “big bang” implementation: Not for the faint of heart. Computers in Nursing 20(1), 14–20 (2002)Google Scholar
  39. 39.
    Ash, J.S., Bates, D.W.: Factors and forces affecting EHR system adoption: Report of a 2004 ACMI discussion. J. Am. Med. Inform. Assoc. 12(1), 8–12 (2005)CrossRefGoogle Scholar
  40. 40.
    Brokel, J.M., Harrison, M.I.: Redesigning care processes using an electronic health record: A system’s experience. Joint Commission Journal on Quality and Patient Safety 35(2), 82–92 (2009)Google Scholar
  41. 41.
    McAlearney, A.S., et al.: Moving from good to great in ambulatory electronic health record implementation. Journal for Healthcare Quality: Official Publication of the National Association for Healthcare Quality 32(5), 41–50 (2010)CrossRefGoogle Scholar
  42. 42.
    Whittaker, A.A., Aufdenkamp, M., Tinley, S.: Barriers and facilitators to electronic documentation in a rural hospital. Journal of Nursing Scholarship 41(3), 293–300 (2009)CrossRefGoogle Scholar
  43. 43.
    Yan, H., Gardner, R., Baier, R.: Beyond the focus group: Understanding physicians’ barriers to electronic medical records. Jt. Comm. J. Qual. Patient Saf. 38(4), 184–191 (2012)Google Scholar
  44. 44.
    Aaronson, J.W., et al.: Electronic medical records: the family practice resident perspective. Fam. Med. 33(2), 128–132 (2001)MathSciNetGoogle Scholar
  45. 45.
    Keenan, C.R., Nguyen, H.H., Srinivasan, M.: Electronic medical records and their impact on resident and medical student education. Acad. Psychiatry 30(6), 522–527 (2006)CrossRefGoogle Scholar
  46. 46.
    Terry, A.L., et al.: Adoption of electronic medical records in family practice: The providers’ perspective. Fam. Med. 41(7), 508–512 (2009)Google Scholar
  47. 47.
    Mintz, M., et al.: Use of electronic medical records by physicians and students in academic internal medicine settings. Acad. Med. 84(12), 1698–1704 (2009)CrossRefGoogle Scholar
  48. 48.
    Chumley, H., et al.: First-year medical students document more pain characteristics when using an electronic health record. Fam. Med. 40(7), 462–463 (2008)Google Scholar
  49. 49.
    Carr, D.M.: A team approach to EHR implementation and maintenance. Nurs. Manage, 35(suppl. 5) 15–6, 24 (2004)Google Scholar
  50. 50.
    Lorenzi, N.M., et al.: How to successfully select and implement electronic health records (EHR) in small ambulatory practice settings. Bmc. Medical Informatics and Decision Making 9(1) (2009)Google Scholar
  51. 51.
    Report II: Contemporary Issues in Medicine: Medical Informatics and Population Health. Medical School Objectives Project (1998)Google Scholar
  52. 52.
    Gliatto, P., Masters, P., Karani, R.: Medical student documentation in the medical record: is it a liability? Mt. Sinai. J. Med. 76(4), 357–364 (2009)CrossRefGoogle Scholar
  53. 53.
    Stephens, M.B., Gimbel, R.W., Pangaro, L.: Commentary: The RIME/EMR scheme: An educational approach to clinical documentation in electronic medical records. Acad. Med. 86(1), 11–14 (2011)CrossRefGoogle Scholar
  54. 54.
    Cate, O., Scheele, F.: Viewpoint: Competency-Based Postgraduate Training: Can We Bridge the Gap between Theory and Clinical Practice? Academic Medicine 82(6), 542–547 (2007)CrossRefGoogle Scholar
  55. 55.
    Carter, J.H., American College of Physicians (2003): Electronic health records: A guide for clinicians and administrators, 2nd edn., p. 530. ACP Press. xxi, Philadelphia (2008)Google Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Min Soon Kim
    • 1
    • 2
  • Martina A. Clarke
    • 2
  • Jeffery L. Belden
    • 3
  • Elaine Hinton
    • 4
  1. 1.Department of Health Management and InformaticsUniversity of MissouriUSA
  2. 2.University of Missouri Informatics InstituteUniversity of MissouriUSA
  3. 3.Department of Family and Community MedicineUniversity of MissouriUSA
  4. 4.Center for Education and DevelopmentUniversity of MissouriUSA

Personalised recommendations