- Patient and provider satisfaction with EHR systems remains lacking despite improvements in health data availability, access, and exchange.
This finding comes from a recent JAMIA study by Meyerhoefer et al. at Lehigh University.
The team of researchers collected data on provider satisfaction through four survey rounds during a phased EHR implementation at Lehigh Valley Health Network (LVHN).
The implementation included three stages spanning 2010-2013. Researchers surveyed levels of clinician satisfaction among 108 LVHN providers at four different points throughout the implementation process. Meanwhile, the team administered and collected patient satisfaction surveys continuously throughout the launch.
During stage 1 of the implementation process, the health network implemented an ambulatory EHR system. Providers had the ability to exchange discrete health data from the ambulatory EHR system to the inpatient EHR system in a triage subunit of labor and delivery.
In stage 2, providers had the ability to automatically send triage discharge summaries from the inpatient EHR system to the ambulatory EHR system in OB/GYN offices.
Finally, stage 3 denoted the period during which providers were able to send discrete clinical data and enhanced discharge summaries from the inpatient EHR system in triage to the ambulatory EHR system.
“The provider survey asked about both the availability of data from triage visits and the respondent’s satisfaction with the EHR system, and we analyze these responses separately,” explained researchers in the study report. “Survey responses could range from 1 (disagree strongly) to 5 (agree strongly).”
Researchers gained insight into levels of patient satisfaction through 8,000 survey responses from patients seen at LVHN OB/GYN offices from January 2007 through December 2012.
While provider satisfaction with EHR technology remained negative throughout all three stages of the implementation process, satisfaction levels did improve slightly over time.
During stage 2 of the implementation, providers agreed clinical documentation from triage visits was successfully integrated into the prenatal health record than during stage 1. Providers also agreed that the increased availability of triage information lessened the likelihood that potentially harmful errors would threaten patient safety.
Additionally, providers agreed improvements in the triage health data access assisted with patient management.
“By 2013 when there was complete two-way exchange of information, clinical staff agreed that triage information is easily accessible and incorporated into the office prenatal record to a greater extent, while they agreed that lack of information about triage visits makes it difficult to manage patients or is likely to cause harm to a lesser extent,” wrote researchers.
Despite improvements in health data access and exchange between care settings, researchers confirmed physicians remained uniformly dissatisfied with EHR technology throughout the implementation.
Patient satisfaction similarly remained low throughout the implementation.
“Patients were also unhappy; their satisfaction with almost all aspects of office visits decreased after installation of the ambulatory EHR, and, while further reductions in satisfaction occurring in subsequent stages of EHR implementation were smaller and often not statistically significant, it is striking that we find not a single positive and significant marginal effect of full two-way integration,” wrote researchers.
However, levels of patient satisfaction bounced back to their original levels prior to the EHR implementation as providers became better accustomed to using the new system.
“The link between physician and patient dissatisfaction is consistent with research showing that provider job satisfaction influences interpersonal relationships with patients and their satisfaction with care,” noted researchers.
This finding suggests that the initial disruptions to daily operations that often accompany a new EHR implementation can negatively affect patients as well as providers. Patients became more dissatisfied after interacting with dissatisfied physicians.
“Complete integration of the ambulatory EHR with the inpatient EHR and greater provider experience with the system did not, in itself, reverse the negative impact on patient satisfaction, possibly because the majority of patients (GYN) did not benefit from the integration with the hospital, but only perceived the disruptions and changes in work processes that caused physician dissatisfaction,” researchers wrote.
To keep levels of patient satisfaction high during EHR implementations, researchers recommended health systems train non-clinical staff on strategies to improve communication with patients about administrative matters during the deployment process.
“Further, our results reinforce calls made by others for more thought and training on integrating computers with face-to-face interactions,” suggested researchers.
“However, the fact that the benefits of integration were not enough to compensate for the negative impacts of the EHR on physicians suggests that healthcare systems may need to better protect physicians from the negative consequences of EHR adoption,” the team added.
While levels of patient and provider satisfaction with EHR technology remains low in the early days after implementation, clinicians can help to boost patient satisfaction as they learn to more efficiently use the systems.