Physicians want usability and decision support in EMRs

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 - Dr. Laptop

When it comes to promoting acceptance of EMRs in hospitals, physicians are primarily concerned with ease of use and the added value (in the form of decision support) provided by the systems, according to research published online June 5 in the journal Implementation Science.

The researchers, led by Mattijs S. Lambooij, Department Quality of Care and Health Economics, National Institute for Public Health and the Environment (RIVM), Center for Nutrition, Prevention and Health Services, Bilthoven, The Netherlands, also found that while nurses show many similarities with physicians when it comes to the attributed of an EMR—such as ease of use—they also are concerned with the amount of  managerial support they receive when it comes to EMR implementation.

“Implications for the practices of implementation is that for physicians the innovation need[s] to be fully developed and have immediate ease of use and added value,” the authors wrote, “while for the nurses the managerial support can positively affect the implementation process…”

For the study, the researchers used a discrete choice experiment to quantify the relative importance of certain factors concerning the willingness to use an EMR among physicians and nurses. The respondents included150 physicians and 148 nurses from different hospitals in the Netherlands who had experience using EMRs.

In addition to ease-of-use and the presence of decision support in the EMR, physicians also placed the most emphasis on performance feedback, followed by managerial support. Nurses, on the other hand, ranked ease of use as the most important factor, followed by managerial support, the presence of decision support and performance feedback.

According to authors, based on attitudes towards decision support, the increasing incorporation of decision support in EMRs going forward suggests that users will be more likely to enthusiastically embrace future generations of EMRs.

The presence of performance feedback features also suggests it may be possible to motivate physicians and nurses when they receive reports of inferior of inconsistent care. “This is a potentially useful outcome for policymakers who are involved in improving healthcare, but also for implementers of the EMR,” the authors wrote. “A performance feedback system can make clinicians aware of their delivered quality of care and thereby contribute to the improvement of quality of care.”

One unexpected finding, the authors noted, is that nurses and physicians prefer the use of workstations rather than tablets when it comes to navigating within the EMR. Possible reasons, according to the authors, could be that many EMRs contain multiple tabs, which would make it easier to use from a desktop computer, and that using a tablet for data entry may involve incorporating new techniques that will require a change in behavior.

The authors concluded that  while their study may be “a snapshot in time,” policymakers, implementers and developers of EMRs “may use the information to fine tune implementation processes and anticipate the preferences of the users and future implementation processes.”

Specifically, the fact that physicians are concerned with ease of use and added value means that during implementation an EMR needs to “function flawlessly and should be easy to work with in order to gain support from physicians," the authors wrote. Nurses, on the other hand, need to be assured they will receive managerial support in order to encourage their acceptance of the EMR.