How well is the electronic health record supporting the clinical tasks of hospital physicians? A survey of physicians at three Norwegian hospitals

Abstract

Background: The electronic health record is expected to improve the quality and efficiency of health care. Many novel functionalities have been introduced in order to improve medical decision making and communication between health care personnel. There is however limited evidence on whether these new functionalities are useful. The aim of our study was to investigate how well the electronic health record system supports physicians in performing basic clinical tasks.

Methods: Physicians of three prominent Norwegian hospitals participated in the survey. They were asked, in an online questionnaire, how well the hospital's electronic health record system DIPS supported 49 clinical tasks as well as how satisfied they were with the system in general, including the technical performance. Two hundred and eight of 402 physicians (52%) submitted a completely answered questionnaire.

Results: Seventy-two percent of the physicians had their work interrupted or delayed because the electronic health record hangs or crashes at least once a week, while 22% had experienced this problem daily. Fifty-three percent of the physicians indicated that the electronic health record is cumbersome to use and adds to their workload. The majority of physicians were satisfied with managing tests, e.g., requesting laboratory tests, reading test results and managing radiological investigations and electrocardiograms. Physicians were less satisfied with managing referrals. There was high satisfaction with some of the decision support functionalities available for prescribing drugs. This includes drug interaction alerts and drug allergy warnings, which are displayed automatically. However, physicians were less satisfied with other aspects of prescribing drugs, including getting an overview of the ongoing drug therapy.

Conclusions: In the survey physicians asked for improvements of certain electronic health record functionalities like medication, clinical workflow support including planning and better overviews. In addition, there is apparently a need to focus on system stability, number of logins, reliability and better instructions on available electronic health record features. Considerable development is needed in current electronic health record systems to improve usefulness and satisfaction.

Keywords: Clinical decision support; Clinical task; Electronic health record; Hospital physician; Information and communication technology.

Fig. 1

Satisfaction with functionalities. Respondents’ satisfaction with features of the EHR system. The questions used the phrasing ‘How satisfied are you with the support in DIPS for […]’, and are here abbreviated (and translated into English). The five response options ranged from ‘Very dissatisfied’ to ‘Very satisfied’, and the figure shows the percentage of respondents for each response option. The number of responses for each question is shown in the column to the right. Items with less than 30 responses are omitted

Fig. 2

Flowchart. The flowchart displays the sequence of questions used in the survey

Fig. 3

Priority of developing functionalities. Respondents’ view on the importance of developing / improving various features of the EHR system. The questions used the phrasing ‘How important is it to develop / improve […]’ (Fig. 1). The four response options ranged from ‘Not important’ to ‘Very important’, and are scored from 0 to 3. The circles correspond to the mean scores, and the lines to 95% confidence intervals. The number of respondents for each question is shown in parentheses after the question titles

Fig. 4

Overall satisfaction with the EHR. Respondents’ view on the overall quality of the EHR system. The question was introduced by the following text. ‘Lastly, we want to ask you a few questions on the overall quality of the EHR. What’s your opinion on the following statements?’ The five response options ranged from ‘Completely disagree’ to ‘Completely agree’. An equal number of positively and negatively worded (marked with * in the figure) statements was used. Here, the responses have been recoded so that high values always correspond to high satisfaction with the EHR