title: A Two-Year Longitudinal Assessment of Ophthalmologists' Perceptions after Implementing an Electronic Health Record System.
abstract: To understand the attitudes and perceptions of ophthalmologists toward an electronic health record (EHR) system, before and after its clinical implementation.
  
  
  
  Ophthalmologists at a single large academic ophthalmology department were surveyed longitudinally before and after implementation of a new EHR system. The survey measured ophthalmologists' attitudes toward implementation of a new EHR. Questions focused on satisfaction, efficiency, and documentation. All attending physicians (between 56 and 61 at various time points) in the University of Michigan Department of Ophthalmology and Visual Sciences were surveyed. We plotted positive responses to survey questions and assessed whether perceptions followed a J-curve with an initial decrease followed by an increase surpassing pre-implementation levels.
  
  
  
  Survey responses were received from 32 (52%) ophthalmologists pre-implementation, and 28 (46%) at 3 months, 35 (57%) at 7 months, 40 (71%) at 13 months and 39 (67%) at 24 months post-implementation. After EHR implementation respondents were more likely to express concerns about their ability to create high-quality documentation (p<0.01) and the impact of an electronic health record on meaningful patient interaction (p<0.01). Physicians did not report a significant change in the amount of time spent documenting outside of regular clinical work hours (p=0.54) or on their clinic efficiency and workflow (p=0.97). There was no significant change in overall job satisfaction during the study period (p=0.69). We did not observe a J-curve for any of the survey responses analyzed.
  
  
  
  As ophthalmology practices continue to transition to EHRs, adapting them to their specific culture and needs is important to maintain efficiency and user satisfaction. This study identifies areas of concern to ophthalmologists that may be addressed through education of physicians and customization of software as other practices move forward with EHR implementation.
authors.forename: Joshua R
authors.initials: JR
authors.lastname: Ehrlich
authors.forename: Monica
authors.initials: M
authors.lastname: Michelotti
authors.forename: Taylor S
authors.initials: TS
authors.lastname: Blachley
authors.forename: Kai
authors.initials: K
authors.lastname: Zheng
authors.forename: Mick P
authors.initials: MP
authors.lastname: Couper
authors.forename: Grant M
authors.initials: GM
authors.lastname: Greenberg
authors.forename: Sharon
authors.initials: S
authors.lastname: Kileny
authors.forename: Greta L
authors.initials: GL
authors.lastname: Branford
authors.forename: David A
authors.initials: DA
authors.lastname: Hanauer
authors.affiliation: Jennifer S. Weizer, MD, Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, 1000 Wall Street, Ann Arbor, MI 48105, Fax: (734) 232-0865, Telephone: (734) 936-9503, Email: jweizer@med.umich.edu.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Weizer
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D000072163:Ophthalmologists / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Ophthalmology; clinical documentation and communications; electronic health records and systems; implementation and deployment; testing and evaluation