Two-year longitudinal assessment of physicians' perceptions after replacement of a longstanding homegrown electronic health record: does a J-curve of satisfaction really exist?

Abstract

This report describes a 2-year prospective, longitudinal survey of attending physicians in 3 clinical areas (family medicine, general pediatrics, internal medicine) who experienced a transition from a homegrown electronic health record (EHR) to a vendor EHR. Participants were already highly familiar with using EHRs. Data were collected 1 month before and 3, 6, 13, and 25 months post implementation. Our primary goal was to determine if perceptions followed a J-curve pattern in which they initially dropped but eventually surpassed baseline measures. A J-curve was not found for any measures, including workflow, safety, communication, and satisfaction. Only the reminders and alerts measure dropped and then returned to baseline (U-curve); a few remained flatlined. Most dropped and remained below baseline (L-curve). The only measure that remained above baseline was documenting in the exam room with the patient. This study adds to the literature about current controversies surrounding EHR adoption and physician satisfaction.

Keywords: ambulatory care; electronic health records; longitudinal studies; physicians; survey methods.

Figure 1.

Illustrative quotes representing sentiments expressed at the different time points during the longitudinal survey. These were drawn from 559 comments left by the respondents, totaling 56 303 words. Quotes from the same specialty are not necessarily from the same physicians each time. Note that CareWeb was the legacy homegrown EHR used from 1998 to 2012, and MiChart is the local name for the replacement vendor EHR.