Effects of electronic health records implementation on workflow and health care provider outcomes: a prospective, multi-professional cohort study.

BACKGROUND

Prospective studies examining electronic health record (EHR) implementation in multi-professional healthcare provider samples remain scarce, particularly with respect to impacts on providers' workflows and outcomes in real-world clinical settings.

OBJECTIVES

To determine the prospective effects of workflow interruptions, multitasking, information overload, and burnout over time among physicians and nurses in before and after EHR adoption.

MATERIALS AND

METHODS

Multi-methods, unit-based, and before-after-design was established to determine provider experiences before and after EHR implementation (5 months-time lag). Information on key outcome variables was assessed via standardized surveys among healthcare professionals and augmented through qualitative interviews with stakeholders to determine the quality of the EHR implementation. Prospective effects were determined within and across professions with multivariate analyses.

RESULTS

A total of 163 physicians and nurses participated (baseline: n = 87, follow-up: n = 76). Interviews revealed different implementation strategies across professions with varying procedures, training opportunities, and resources: nurses were supported via a more structured and on-site EHR introduction process, whereas physicians were offered a more self-directed and organized process. Overall, we did not find significant differences over time for workflow variables and burnout. Moderation analyses showed 2 significant effects: information overload for nurses was significantly reduced at follow-up; reported depersonalization in physicians was higher at follow-up.

DISCUSSION: This prospective study provides important contributions into the varying effects of profession-specific EHR adoption processes for provider workflow and burnout. EHR utilization did not per se improve workflow and provider experience.

CONCLUSION

Future studies should investigate the interplay of profession-specific management of EHR adoption processes and respective provider outcomes.