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Take Note(s): Differential EHR Satisfaction with Two Implementations under One Roof

Affiliations of the authors: Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (RTO, NS, KB); Department of Pediatrics, Yale University School of Medicine, New Haven, CT (CC, RNS); Center for Medical Informatics, Yale University School of Medicine, New Haven, CT (RNS), USA

Correspondence and reprints: Ryan T. O'Connell, MD, Yale Center for Medical Informatics, 300 George Street, Suite 501, New Haven, CT 06511; e-mail: <ryan{at}oconnell.org>.

Received for publication: 06/12/03; accepted for publication: 09/11/03.

Objective: The aim of this study was to rigorously evaluate perceived differences in satisfaction with an electronic health record (EHR) between residents of two medical specialties who share the same health record, practice location, administration, and information technology support.

Design: A cross-sectional survey was used comparing user satisfaction between pediatrics residents and internal medicine residents in an academic practice.

Measurements: The survey was designed to measure baseline demographic characteristics, attitudes toward computers, general satisfaction with an EHR, and perceived practicality of use, variation from familiar practice, organizational support, and impact on delivery of care.

Results: Medicine subjects were similar to pediatrics subjects in baseline demographic characteristics. Satisfaction with the EHR implementation was very high for both sets of subjects, but internal medicine residents were significantly less likely to be satisfied with the EHR implementation (relative risk [RR] = 0.84, 95% confidence interval [CI] = 0.73–0.98) and considerably less likely to believe that their colleagues were satisfied with it (RR = 0.56, 95% CI = 0.41–0.77). The only surveyed characteristic independently predicting satisfaction was medical specialty (p = 0.04). Medicine subjects were less likely to believe template-based documentation improved their efficiency (RR = 0.64, 95% CI = 0.46–0.88). They were significantly more likely to believe the system had been designed to improve billing (RR = 1.50, 95% CI = 1.05–2.04) and not to improve patient care (RR = 0.61, 95% CI = 0.44–0.85).

Conclusion: The authors found a difference in satisfaction between internal medicine and pediatrics users of an EHR. Although many potential factors that influence satisfaction were similar between subjects in the two specialties, differences in previous experience may have influenced the results. Medicine residents had more previous experience with a different EHR implementation, which they may have perceived as superior to the one involved in this study. Pediatric residents had more previous experience with structured data entry prior to EHR implementation and more preventive care patient encounters for which structured data entry may be well suited. Since successful implementations generally require satisfied users, understanding what factors affect satisfaction can improve chances of a system's success.