title: Patient safety perceptions of primary care providers after implementation of an electronic medical record system.
abstract: BACKGROUND
  Increasing the use of electronic medical records (EMR) has been suggested as an important strategy for improving healthcare safety.
  
  
  OBJECTIVE
  To sequentially measure, evaluate, and respond to safety culture and practice safety concerns following EMR implementation.
  
  
  METHODS
  Safety culture was assessed using a validated tool (Safety Attitudes Questionnaire; SAQ), immediately following EMR implementation (T1) and at 1.5 (T2) and 2.5 (T3) years post-implementation. The SAQ was supplemented with a practice-specific assessment tool to identify safety needs and barriers.
  
  
  METHODS
  A large medical group practice with a primary care core of 17-18 practices, staffed by clinicians in family medicine, pediatrics, internal medicine.
  
  
  METHODS
  Survey results were used to define and respond to areas of need between assessments with system changes and educational programs.
  
  
  METHODS
  Change in safety culture over time; perceived impact of EMR on practice.
  
  
  RESULTS
  Responses were received from 103 of 123 primary care providers in T1 (83.7 % response rate), 122 of 143 in T2 (85.3 %) and 142 of 181 in T3 (78.5 %). Safety culture improved over this period, with statistically significant improvement in all domains except for stress recognition. Time constraints, communications and patient adherence were perceived to be the most important safety issues. The majority of respondents in both T2 (77.9 %) and T3 (85.4 %) surveys agreed that the EMR improved their ability to provide care more safely.
  
  
  CONCLUSIONS
  Implementation of an EMR in a large primary care practice required redesign of many organizational processes, and was associated with improvements in safety culture. Most primary care providers agreed that the EMR allowed them to provide care more safely.
authors.affiliation: Johns Hopkins Community Physicians, 3100 Wyman Park Drive, Room 340, Baltimore, MD 21211, USA. mmcguir1@jhmi.edu
authors.forename: Maura J
authors.initials: MJ
authors.lastname: McGuire
authors.forename: Gary
authors.initials: G
authors.lastname: Noronha
authors.forename: Lipika
authors.initials: L
authors.lastname: Samal
authors.forename: Hsin-Chieh
authors.initials: HC
authors.lastname: Yeh
authors.forename: Susan
authors.initials: S
authors.lastname: Crocetti
authors.forename: Steven
authors.initials: S
authors.lastname: Kravet
mesh_terms: D001291:Attitude of Health Personnel; D057286:Electronic Health Records / Q000458:organization & administration*; D006302:Health Services Research / Q000379:methods; D006801:Humans; D008396:Maryland; D020380:Needs Assessment; D015279:Organizational Culture; D061214:Patient Safety / Q000592:standards*; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards*; D058996:Quality Improvement; D011795:Surveys and Questionnaires