Evaluation of electronic medical records - A clinical task perspective

Abstract

Evaluation is a challenging but necessary part of the development cycle of clinical information systems like the complex electronic medical records (EMR) systems. It is believed that evaluations of EMR systems should include multiple perspectives, be comparative and employ both qualitative and quantitative methods. Self-administered questionnaires are frequently used as a quantitative evaluation method in medical informatics, but very few validated questionnaires address clinical use of EMR systems, and comparative investigations are scarce.

A task-oriented questionnaire has been developed for evaluating EMR systems from the physician’s perspective. The key feature of the questionnaire is a list of 24 general clinical tasks. The list of tasks is applicable to physicians of most specialties and covers essential parts of their information-oriented work. The list appears as in two separate sections, about EMR use and task performance using the EMR, respectively. Using the questionnaire, the evaluator may quickly estimate the potential impact of the EMR system on health care delivery. Problematic areas may be found by identifying clinical tasks for which the EMR system either is not used, or for which performing the task is more difficult when using the system. These results may be compared across time, site or vendor. The development, application and validation of the questionnaire is described in this thesis. Its performance is demonstrated in a national and a local study.

In addition to underscoring the performance of the questionnaire, the demonstration studies had interesting results of their own. The national study showed that a considerable proportion of the functionality offered by the EMR systems is not used by the physicians. The local study showed that scanning and eliminating the paper-based medical record in middle-sized hospital is feasible. All physicians used the EMR system more much frequently, and while a considerable proportion of the internists found important tasks more difficult, most physicians found their EMR-supported tasks easier to perform. However, the medical secretaries in this hospital were considerably more satisfied with the system, and overall seemed to benefit more from this change in the work environment than both the physicians and the nurses.

The questionnaire presented here may be used as part of any evaluation effort involving the clinician’s perspective of an EMR system.