Evaluation of Electronic Medical Record (EMR) at Large Urban Primary Care Sexual Health Centre

Objective Despite substantial investment in Electronic Medical Record (EMR) systems there has been little research to evaluate them. Our aim was to evaluate changes in efficiency and quality of services after the introduction of a purpose built EMR system, and to assess its acceptability by the doctors, nurses and patients using it. Methods We compared a nine month period before and after the introduction of an EMR system in a large sexual health service, audited a sample of records in both periods and undertook anonymous surveys of both staff and patients. Results There were 9,752 doctor consultations (in 5,512 consulting hours) in the Paper Medical Record (PMR) period and 9,145 doctor consultations (in 5,176 consulting hours in the EMR period eligible for inclusion in the analysis. There were 5% more consultations per hour seen by doctors in the EMR period compared to the PMR period (rate ratio = 1.05; 95% confidence interval, 1.02, 1.08) after adjusting for type of consultation. The qualitative evaluation of 300 records for each period showed no difference in quality (P>0.17). A survey of clinicians demonstrated that doctors and nurses preferred the EMR system (P<0.01) and a patient survey in each period showed no difference in satisfaction of their care (97% for PMR, 95% for EMR, P = 0.61). Conclusion The introduction of an integrated EMR improved efficiency while maintaining the quality of the patient record. The EMR was popular with staff and was not associated with a decline in patient satisfaction in the clinical care provided.

[1]  T. Peters,et al.  The quality of record keeping in primary care: a comparison of computerised, paper and hybrid systems. , 2003, The British journal of general practice : the journal of the Royal College of General Practitioners.

[2]  C. K. Barsukiewicz,et al.  Investigating changes in end-user satisfaction with installation of an electronic medical record in ambulatory care settings. , 1998, Journal of healthcare information management : JHIM.

[3]  S. Garland,et al.  Sexually transmitted diseases in disadvantaged Australian communities. , 1997, JAMA.

[4]  Tom Bowden,et al.  Electronic Medical Record Adoption in New Zealand Primary Care Physician Offices , 2010 .

[5]  Arild Faxvaag,et al.  Norwegians GPs' use of electronic patient record systems , 2009, Int. J. Medical Informatics.

[6]  Robyn Tamblyn,et al.  Review Paper: The Impact of Electronic Health Records on Time Efficiency of Physicians and Nurses: A Systematic Review , 2005, J. Am. Medical Informatics Assoc..

[7]  Sharon E. Straus,et al.  The impact of the electronic medical record on structure, process, and outcomes within primary care: a systematic review of the evidence , 2011, J. Am. Medical Informatics Assoc..

[8]  Gregory M Garrison,et al.  21st-century health care: the effect of computer use by physicians on patient satisfaction at a family medicine clinic. , 2002, Family medicine.

[9]  Mark D. Schwartz,et al.  Computers in the Exam Room: Differences in Physician–Patient Interaction May Be Due to Physician Experience , 2007, Journal of General Internal Medicine.

[10]  David Bomba.  Moving beyond implementation to sustained use of computers in general practice in Australia , 2004 .

[11]  J. Wei.  Productivity and Cost Implications of Implementing Electronic Medical Records Into an Ambulatory Surgical Subspecialty Clinic , 2008 .

[12]  J. Hippisley-Cox,et al.  The electronic patient record in primary care—regression or progression? A cross sectional study , 2003, BMJ : British Medical Journal.

[13]  Michael F Furukawa,et al.  Electronic medical records and efficiency and productivity during office visits. , 2011, The American journal of managed care.

[14]  J. Hocking,et al.  Computer Assisted Self Interviewing in a Sexual Health Clinic as Part of Routine Clinical Care; Impact on Service and Patient and Clinician Views , 2011, PloS one.

[15]  Christopher Pearce,et al.  Electronic medical records--where to from here? , 2009, Australian family physician.

[16]  Adam D. Cheriff,et al.  Physician productivity and the ambulatory EHR in a large academic multi-specialty physician group , 2010, Int. J. Medical Informatics.

[17]  Spencer S Jones,et al.  Unraveling the IT productivity paradox--lessons for health care. , 2012, The New England journal of medicine.

[18]  Catherine H Mercer,et al.  Vicious and virtuous circles in the dynamics of infectious disease and the provision of health care: gonorrhea in Britain as an example. , 2005, The Journal of infectious diseases.

[19]  Joanne L Callen,et al.  Patients' Perceptions of General Practitioners Using Computers during the Patient-Doctor Consultation , 2005, Health information management : journal of the Health Information Management Association of Australia.

[20]  Simon de Lusignan,et al.  Viewpoint Paper: e-Prescribing, Efficiency, Quality: Lessons from the Computerization of UK Family Practice , 2006, J. Am. Medical Informatics Assoc..