title: Two-year longitudinal assessment of physicians' perceptions after replacement of a longstanding homegrown electronic health record: does a J-curve of satisfaction really exist?
abstract: This report describes a 2-year prospective, longitudinal survey of attending physicians in 3 clinical areas (family medicine, general pediatrics, internal medicine) who experienced a transition from a homegrown electronic health record (EHR) to a vendor EHR. Participants were already highly familiar with using EHRs. Data were collected 1 month before and 3, 6, 13, and 25 months post implementation. Our primary goal was to determine if perceptions followed a J-curve pattern in which they initially dropped but eventually surpassed baseline measures. A J-curve was not found for any measures, including workflow, safety, communication, and satisfaction. Only the reminders and alerts measure dropped and then returned to baseline (U-curve); a few remained flatlined. Most dropped and remained below baseline (L-curve). The only measure that remained above baseline was documenting in the exam room with the patient. This study adds to the literature about current controversies surrounding EHR adoption and physician satisfaction.
authors.affiliation: Department of Pediatrics, University of Michigan Health System.|School of Information, University of Michigan.
authors.forename: David A
authors.initials: DA
authors.lastname: Hanauer
authors.affiliation: Department of Internal Medicine, University of Michigan Health System.
authors.forename: Greta L
authors.initials: GL
authors.lastname: Branford
authors.affiliation: Department of Family Medicine, University of Michigan Health System.
authors.forename: Grant
authors.initials: G
authors.lastname: Greenberg
authors.affiliation: Department of Pediatrics, University of Michigan Health System.
authors.forename: Sharon
authors.initials: S
authors.lastname: Kileny
authors.affiliation: Institute for Social Research, University of Michigan.
authors.forename: Mick P
authors.initials: MP
authors.lastname: Couper
authors.affiliation: School of Information, University of Michigan.|School of Public Health, University of Michigan.
authors.forename: Kai
authors.initials: K
authors.lastname: Zheng
authors.affiliation: Department of Pediatrics, University of Michigan Health System.|Blood and Marrow Transplantation Program, University of Michigan Health System.
authors.forename: Sung W
authors.initials: SW
authors.lastname: Choi
mesh_terms: D000553:Ambulatory Care / Q000458:organization & administration; D001291:Attitude of Health Personnel; D001292:Attitude to Computers; D004059:Diffusion of Innovation; D057286:Electronic Health Records; D005194:Family Practice; D006785:Hospitals, University; D006801:Humans; D007388:Internal Medicine; D008137:Longitudinal Studies; D008824:Michigan; D061214:Patient Safety; D010372:Pediatrics; D010820:Physicians / Q000523:psychology; D057188:Workflow
keywords: ambulatory care; electronic health records; longitudinal studies; physicians; survey methods