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The truth about declining clinician satisfaction with EPRs

As electronic patient records (EPRs)* become commonplace, there’s more we can learn from clinician feedback. It’s important to know what they think, because staff perception shapes satisfaction, adoption rates and ultimate success and impact with EPRs clinically and organizationally.

It was a privilege to contribute to the recent article in HSS Journal about clinician satisfaction and its variability over time.  Working with an orthopedic teaching hospital moving from a paper-based system to an EPR, we found that clinicians were initially elated with the change. Then their satisfaction dropped. What a curious pattern, since anecdotally their satisfaction and adoption continued to rise.

At first, this change in satisfaction sounded like a bad thing. No one wants to see EPR satisfaction decreasing, right? But after evaluating the results reported in this study, I’d argue it’s exactly what we should have anticipated we’d see. And it is good news.

Factors that affect clinician satisfaction with EPRs

A multidisciplinary team developed a 22-question survey to measure clinician satisfaction. We focused on patient demographics, orders, medications, laboratory and radiology data. We wanted to know if clinicians could:

  • Easily obtain data needed to take care of patients
  • Easily act upon the data
  • Receive clear and understandable data
  • Receive alerts about potential safety problems

We distributed this survey just before the EPR “go-live,” and at six and 12 months afterwards. There are a lot of results that the article covers in great detail, but here is a chart to help summarize:

You can see from Figure 1 that clinicians’ satisfaction with orders improves significantly six months after implementation. But then across all categories, satisfaction drops a bit.

Why clinician satisfaction drops off

Six months after they started using an EPR, clinicians had a high level of satisfaction, as we hoped for and expected. It’s because they’ve become comfortable using the system, and they are seeing benefits over the previous ways of doing things.

However we see a curiously different story one year after implementation as satisfaction seems to decline. Interviews showed that as familiarity set in, clinicians realized what the system could do and wanted more.

This thirst for more capability among clinicians is a good thing. It indicates that physicians are engaged enough to want more, and through the EPR. We need to embrace this feedback and find ways to incorporate it.

For this exact reason, Allscripts long ago undertook the development of outcomes toolkits, which are proven, generalizable solution sets, harvested from the successes of client organizations. Using outcomes toolkits, many Allscripts clients have raised their levels of outcomes achievements by learning from their sister organizations.

All EPRs are not created equal

Most EPRs, as reflected in their satisfaction scores, are primarily about adoption and adaptation to the EPR. Basically, clinicians learn to use it with minimal changes possible and, “It is what it is.”

But in this instance, the EPR is adaptable to new and evolving wants and needs. Because it is locally programmable, organizations and clinicians can be innovative within the EPR. That creates a thirst for “what I want to do next.” And that appetite is what drives clinical excellence, continuous improvement, and innovation.

This EPR sparks interest in new capabilities in electronic documentation, patient-adaptive order sets and clinical decision support. So clinicians see all of the things they would like the system to do next. The slight decline in satisfaction materialized, because it signals higher adoption and higher desire to adopt.

Made possible by a locally programmable, adaptable EPR, higher adoption helps spark collaboration and innovation to improve care delivery.

“A Computerized Order Entry System Was Adopted with High User Satisfaction at an Orthopedic Teaching Hospital” HSS Journal Volume 10, Issue 1. February 2014.

Editor’s Note: Electronic Patient Record (EPR) is another term for Electronic Medical Record (EMR) or Electronic Health Record (EHR).

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