Organizational complements to electronic health records in ambulatory physician performance: the role of support staff.
ABSTRACT In industries outside healthcare, highly skilled employees enable substantial gains in productivity after adoption of information technologies. The authors explore whether the presence of highly skilled, autonomous clinical support staff is associated with higher performance among physicians with electronic health records (EHRs). Using data from a survey of general internists, the authors assessed whether physicians with EHRs were more likely to be top performers on cost and quality if they worked with nurse practitioners or physician assistants. It was found that, among physicians with EHRs, those with highly skilled, autonomous staff were far more likely to be top performing than those without such staff (OR 7.0, 95% CI 1.7 to 34.8, p=0.02). This relationship did not hold among physicians without EHRs (OR 1.0). As we begin a national push towards greater EHR adoption, it is critical to understand why some physicians gain from EHR use and others do not.
SourceAvailable from: Asaf BittonJAMA The Journal of the American Medical Association 06/2012; 307(24):2593-4. DOI:10.1001/jama.2012.6663 · 30.39 Impact Factor
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ABSTRACT: Background: Electronic health records (EHRs) are structured, distributed documentation systems that differ from paper charts. These systems require skills not traditionally used to navigate a paper chart and to produce a written clinic note. Despite these differences, little attention has been given to physicians' electronic health record (EHR)-writing and -reading competence. Purposes: This study aims to investigate physicians' self-assessed competence to document and to read EHR notes; writing and reading preferences in an EHR; and demographic characteristics associated with their perceived EHR ability and preference. Methods: Fourteen 5-point Likert scale items, based on EHR system characteristics and a literature review, were developed to measure EHR-writing and -reading competence and preference. Physicians in the midwest region of the United States were invited via e-mail to complete the survey online from February to April 2011. Factor analysis and reliability testing were conducted to provide validity and reliability of the instrument. Correlation and regression analysis were conducted to pursue answers to the research questions. Results: Ninety-one physicians (12.5%), from general and specialty fields, working in inpatient and outpatient settings, participated in the survey. Despite over 3 years of EHR experience, respondents perceived themselves to be incompetent in EHR writing and reading (Mean = 2.74, SD = 0.76). They preferred to read succinct, narrative notes in EHR systems. However, physicians with higher perceived EHR-writing and -reading competence had less preference toward reading succinct (r= - 0.33, p<0.001) and narrative (r= - 0.36, p<0.001) EHR notes than physicians with lower perceived EHR competence. Physicians' perceived EHR-writing and -reading competence was strongly related to their EHR navigation skills (r=0.55, p<0.0001). Conclusions: Writing and reading EHR documentation is different for physicians. Maximizing navigation skills can optimize non-linear EHR writing and reading. Pedagogical questions remain related to how physicians and medical students are able to retrieve correct information effectively and to understand thought patterns in collectively lengthier and sometimes fragmented EHR chart notes.Medical Education Online 02/2013; 18:1-7. DOI:10.3402/meo.v18i0.18634 · 1.27 Impact Factor
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ABSTRACT: OBJECTIVES/HYPOTHESIS: To estimate the usage of electronic medical records (EMRs) in ambulatory otolaryngology and to compare the usage trends between otolaryngologists and physicians in other specialties. STUDY DESIGN: Cross-sectional analysis of data taken from the National Ambulatory Medical Care Survey (NAMCS). METHODS: The 2005 to 2010 NAMCS datasets were analyzed for whether storage of patient records in otolaryngology practices were completely electronic, partly electronic, or paper based. The trend of EMR utilization in the studied period was compared between otolaryngology and other specialties. Furthermore, the usage of different EMR functions (e.g., ordering tests) was also evaluated. RESULTS: The proportion of otolaryngology practices with complete or partial EMR usage increased from 27.0% in 2005 to 2006, to 48.5% in 2009 to 2010 (P < .001), and was projected to increase to 80.3% in 2015 to 2016. Otolaryngologists had variable usage of different functions of EMRs. Neither the overall use of EMRs nor their different functions were statistically different between otolaryngologists and other specialists. Further exploration of data revealed that 34.0% of otolaryngologists intended to install new EMR systems within the following years. Finally, 39.9% of otolaryngologists had plans to apply for Medicare or Medicaid incentive payments, of which 92.3% expected to start meaningful use in 2011. CONCLUSIONS: The increasing utilization of EMRs in ambulatory otolaryngology is an important marker of progress in compliance with health care reform. Despite this upward trend, however, <50% of ambulatory offices had adopted EMRs in 2009 to 2010, and it remains to be seen how the field will adapt to the evolving challenge of EMR adoption and implementation. Laryngoscope, 2013.The Laryngoscope 04/2013; DOI:10.1002/lary.24104 · 2.03 Impact Factor