Physician satisfaction and workflow integration factors associated with electronic medical record implementation in a pediatric hospital

Knowledge about identifiable medical errors contributing to patient harm exists but full utilization of health information technology (HIT) in improving patient safety has not been achieved by pediatric hospitals. One reason cited has been lack of physician satisfaction with HIT. This study examined physician satisfaction with a commercially available electronic medical record (EMR) implementation at a pediatric hospital and proposed strategies for improved satisfaction and workflow integration.The Information Systems Expectations and Experiences (I-SEE) survey was modified to focus questions on outcomes and workflow impact experiences. Interview questions were selected to elicit beliefs surrounding the system and implementation process. Methodological triangulation was selected to reduce bias and validate results. EMR assessment was completed using the updated DeLone and McClean Information Success (IS) framework and the organizational purpose statement.Survey responders averaged 15.9 years experience and represented twenty pediatric specialties (n=36). Interview participants represented nine pediatric specialties and averaged 14.5 years experience (n=15). Reliability analysis of the modified I-SEE indicated excellent internal reliability (alpha=0.91). Overall the decision to change the EMR was understood (75%), however there was mixed support of the change (50%). Generally physicians had no issues adapting to technology change (47%) but indicated decreased job satisfaction (p<0.01). Lack of sufficient IT resources was strongly indicated (67%). Most significantly, 75% felt workflow efficiency declined (p< 0.01), however responses indicated no significant patient safety impact. Three areas identified to be most impacted were: access to patient data (53%, p<0.01), amount of patient-provider interaction time (47%, p<0.01) and amount of time spent entering data (44%, p<0.01). System integration and limited availability of historical data posed care delivery problems. The inability of the EMR to adapt to different care areas was consistently cited. Overall, participants felt the provided training limited their ability to efficiently use the system. EMR implementation failed physician expectations based on both assessments. Outcomes were the only categories not considered a failure.These results demonstrate that EMR implementations must address the heterogeneous nature of pediatric workflows and cultural factors impacting physician satisfaction and adoption of EMR systems. If this is not done the value of the implementation is jeopardized.