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1. Parent Satisfaction With the Electronic Medical Record in an Academic Pediatric Rheumatology Practice

Author

C. Kent Kwoh, Robert M. Boudreau, Michael J. Hannon, Steven J. Spalding, and Paul Rosen

Subjects
Parents, medicine.medical_specialty, Office visits, Electronic medical record, health care facilities, manpower, and services, MEDLINE, Health Informatics, Family satisfaction, Personal Satisfaction, lcsh:Computer applications to medicine. Medical informatics, Pediatrics, digestive system, behavioral disciplines and activities, Patient satisfaction, Ambulatory care, Rheumatology, ambulatory care, health services administration, Medicine, Electronic Health Records, Humans, Pediatric rheumatology, health care economics and organizations, Quality of Health Care, Academic Medical Centers, Original Paper, business.industry, lcsh:Public aspects of medicine, lcsh:RA1-1270, pediatric rheumatology, Family medicine, lcsh:R858-859.7, business, Parent satisfaction
Abstract

BackgroundPatient satisfaction has not been widely studied with respect to implementation of the electronic medical record (EMR). There are few reports of the impact of the EMR in pediatrics. ObjectiveThe objective of this study was to assess the impact of implementation of an electronic medical record system on families in an academic pediatric rheumatology practice. MethodsFamilies were surveyed 1 month pre-EMR implementation and 3 months post-EMR implementation. ResultsOverall, EMR was well received by families. Compared with the paper chart, parents agreed the EMR improved the quality of doctor care (55% or 59/107 vs 26% or 26/99, P < .001). More parents indicated they would prefer their pediatric physicians to use an EMR (68% or 73/107 vs 51% or 50/99, P = .01). ConclusionsTransitioning an academic pediatric rheumatology practice to an EMR can increase family satisfaction with the office visit.

Published
2011

2. A web-based generalist-specialist system to improve scheduling of outpatient specialty consultations in an academic center.

Author

Weiner, Michael, Hoyek, Georges El, Wang, Lynnette, Dexter, Paul R., Zerr, Ann D., Perkins, Anthony J., James, Felgrace, Juneja, Rattan, and El Hoyek, Georges

Subjects
*OUTPATIENT medical care, *MEDICAL errors, *MEDICAL practice, *MEDICAL education, *MEDICAL care, *INTERNET standards, *MEDICINE, *RESEARCH, *FERRANS & Powers Quality of Life Index, *ACADEMIC medical centers, *RESEARCH methodology, *EVALUATION research, *MEDICAL cooperation, *COMPARATIVE studies, *MEDICAL referrals, *RESEARCH funding, *MEDICAL appointments, *OUTPATIENT services in hospitals, MEDICAL standards
Abstract

Background: Failed referrals for specialty care are common and often represent medical errors. Technological structures and processes account for many failures. Scheduling appointments for subspecialty evaluation is a first step in outpatient referral and consultation.Objective: We determined whether moving from paper-based referrals to a Web-based system with automated tracking features was associated with greater scheduling of appointments among referred patients.Design: Staggered implementation of a quality-improvement project, with comparison of intervention and control groups.Participants: Patients 21 or more years of age referred from any of 11 primary-care clinics to any of 25 specialty clinics.Interventions: Faxed referrals were replaced by a Web-based application shared by generalists and specialists, with enhanced communications and automated notification to the specialty office.Measurements: We compared scheduling before and after implementation and time from referral to appointment. A logistic regression analysis adjusted for demographics.Main Results: Among 40,487 referrals, 54% led to scheduled specialty visits before intervention, compared to 83% with intervention. The median time to appointment was 168 days without intervention and 78 days with intervention. Scheduling increased more when duplicate referrals were not generated (54% for single orders, 24% for multiple orders). After adjustment, referrals with the intervention were more than twice as likely to have scheduled visits.Conclusions: With a new Web-based referrals system, referrals were more than twice as likely to lead to a scheduled visit. This system improves access to specialty medical services. [ABSTRACT FROM AUTHOR]

Published
2009
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3. The Use of Electronic Medical Records: Communication Patterns in Outpatient Encounters

Author

Gregory Makoul, Raymond H. Curry, and Paul C. Tang

Subjects
medicine.medical_specialty, Academic Medical Centers, Physician-Patient Relations, Medical Records Systems, Computerized, business.industry, Medical record, Communication, Alternative medicine, Original Investigations, Health Informatics, Health problems, Qualitative analysis, Ambulatory care, Content analysis, Family medicine, Surveys and Questionnaires, medicine, Ambulatory Care, Internal Medicine, Humans, Observational study, business, Psychosocial, health care economics and organizations
Abstract

Objective: To assess physician–patient communication patterns associated with use of an electronic medical record (EMR) system in an outpatient setting and provide an empirical foundation for larger studies. Design: An exploratory, observational study involving analysis of videotaped physician–patient encounters, questionnaires, and medical-record reviews. Setting: General internal medicine practice at an academic medical center. Participants: Three physicians who used an EMR system (EMR physicians) and three who used solely a paper record (control physicians). A total of 204 patient visits were included in the analysis (mean, 34 for each physician). Main Outcome Measures: Content analysis of whether physicians accomplished communication tasks during encounters; qualitative analysis of how EMR physicians used the EMR and how control physicians used the paper chart. Results: Compared with the control physicians, EMR physicians adopted a more active role in clarifying information, encouraging questions, and ensuring completeness at the end of a visit. A trend suggested that EMR physicians might be less active than control physicians in three somewhat more patient-centered areas (outlining the patient's agenda, exploring psychosocial/ emotional issues, discussing how health problems affect a patient's life). Physicians in both groups tended to direct their attention to the patient record during the initial portion of the encounter. The relatively fixed position of the computer limited the extent to which EMR physicians could physically orient themselves toward the patient. Although there was no statistically significant difference between the EMR and control physicians in terms of mean time across all visits, a difference did emerge for initial visits: Initial visits with EMR physicians took an average of 37.5 percent longer than those with control physicians. Summary: An EMR system may enhance the ability of physicians to complete informationintensive tasks but can make it more difficult to focus attention on other aspects of patient communication. Further study involving a controlled, pre-/post-intervention design is justified.

Published
2001