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Clinician Perceptions of an Electronic Medical Record During the First Year of Implementaton in Emergency Services

Chisolm, Deena J. PhD*†‡; Purnell, Tanjala S. MPH§; Cohen, Daniel M. MD†∥; McAlearney, Ann Scheck ScD†‡

doi: 10.1097/PEC.0b013e3181ce2f99
Original Article

Objectives: The objectives of this study were to measure clinician perceptions of the recently implemented electronic medical record (EMR) system in a pediatric emergency department and off-site urgent care centers and to determine how user perceptions changed over time.

Methods: Physicians and nurses from the emergency department/urgent care center were recruited to complete an online survey at 3 points in time: 30 to 89 days (wave 1), 90 to 179 days (wave 2), and 180 to 270 days after implementation (wave 3). Potential predictors of initial satisfaction studied included effort expectancy, performance expectancy, social support, and facilitating conditions, along with user demographics and general attitudes toward technology. Bivariate relationships with satisfaction were assessed using the Wilcoxon rank sum test and correlation analysis. A final multivariate linear regression model was calculated. Change in satisfaction over time was tested using a Wilcoxon signed rank test.

Results: A total of 71 clinicians completed the surveys. Initial satisfaction was strongly associated with perceptions of training and support (facilitating conditions) and with perceived usefulness (performance expectancy). Satisfaction was not associated with user sex, age, or role (physician vs nurse). No significant change was found in any satisfaction measure at wave 2 or 3; however, satisfaction with functionality trended higher and satisfaction with reliability trended lower over the course of use.

Conclusions: Satisfaction with an EMR at its launch generally persisted through the first year of use. Implementation plans must maximize the likelihood of achieving positive early impressions of training, support, and performance to engender high user satisfaction with the EMR.

From the *The Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital; †Department of Pediatrics, The Ohio State University College of Medicine; ‡Division of Health Services Management and Policy, The Ohio State University College of Public Health, Columbus, OH; §Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and ∥Section of Emergency Medicine, Nationwide Children's Hospital, Columbus, OH.

Reprints: Deena J. Chisolm, PhD, The Research Institute at Nationwide Children's Hospital, The Ohio State University, Room JW4982, 700 Children's Dr, Columbus, OH 43205 (e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.