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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 25 Research Studies DisplayedHendrix N, Bazemore A, Holmgren AJ
AHRQ Author: Eden AR
Variation in family physicians' experiences across different electronic health record platforms: a descriptive study.
This AHRQ-authored study analyzed variation in reported usability and satisfaction of family physicians across different electronic health records (EHRs). Participants included 3358 ABFM-certified family physicians who use an EHR with at least 50 total responding physicians. These physicians were given an Internet-based survey between December 2021 and October 2022. The EHR systems analyzed included: Epic, athenahealth, Practice Fusion, Allscripts, Cerner, Greenway, and eClinical Works. The EHRs with the most satisfaction included athenahealth or Epic, while physicians using Allscripts, Cerner, or Greenway were the least likely to be very satisfied. There was a great variation in satisfaction due to EHR-specific factors: this overall influence explained 48% of variation in the probability of being very satisfied with Epic, 46% with eClinical Works, 14% with athenahealth, and 49% with Cerner.
AHRQ-authored.
Citation: Hendrix N, Bazemore A, Holmgren AJ .
Variation in family physicians' experiences across different electronic health record platforms: a descriptive study.
J Gen Intern Med 2023 Oct; 38(13):2980-87. doi: 10.1007/s11606-023-08169-5..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Physician
Apathy NC, Rotenstein L, Bates DW NC, Rotenstein L, Bates DW
Documentation dynamics: note composition, burden, and physician efficiency.
This study’s objective was to analyze how physician clinical note length and composition relate to electronic health record (EHR)-based measures of burden and efficiency that have been tied to burnout. This cross-sectional study examined EHR metadata capturing physician-level measures from 203,728 US-based ambulatory physicians using the Epic Systems EHR between September 2020 and May 2021. The authors calculated physician-level averages for four measures of interest and assigned physicians to overall note length deciles and note composition deciles from six sources, including templated text, manual text, and copy/paste text. They found that physicians in the top decile of note length demonstrated greater burden and lower efficiency than physicians in the median decile level, spending 39% more time in the EHR after hours and closing 5.6 percentage points fewer visits on the same day. Copy/paste use demonstrated a similar dose/response relationship, with top-decile copy/paste users closing 6.8 percentage points fewer visits on the same day and spending more time in the EHR after hours and on days off. Templated text such as Epic’s SmartTools demonstrated a non-linear relationship with burden and efficiency, with very low and very high levels of use associated with increased EHR burden and decreased efficiency.
AHRQ-funded; HS026116.
Citation: Apathy NC, Rotenstein L, Bates DW NC, Rotenstein L, Bates DW .
Documentation dynamics: note composition, burden, and physician efficiency.
Health Serv Res 2023 Jun; 58(3):674-85. doi: 10.1111/1475-6773.14097..
Keywords: Provider: Physician, Burnout, Electronic Health Records (EHRs), Health Information Technology (HIT)
Apathy NC, Hare AJ, Fendrich S
I had not time to make it shorter: an exploratory analysis of how physicians reduce note length and time in notes.
The authors analyzed observed reductions in physicians’ note length and documentation time, both of which contribute to EHR burden and burnout. Their study used EHR metadata for ambulatory physician Epic users and examined changes in note composition of physicians who decreased note length and/or documentation time. Their findings showed that note length decreases were primarily attributable to reductions in copy/paste text and templated text, while note time decreases were primarily attributable to reductions in manual text. They concluded that future research should explore scalable burden-reduction initiatives that are responsive to both note bloat and documentation time.
AHRQ-funded; HS026116.
Citation: Apathy NC, Hare AJ, Fendrich S .
I had not time to make it shorter: an exploratory analysis of how physicians reduce note length and time in notes.
J Am Med Inform Assoc 2023 Jan18; 30(2):355-60. doi: 10.1093/jamia/ocac211..
Keywords: Provider: Physician, Burnout, Electronic Health Records (EHRs), Health Information Technology (HIT)
Livaudais M, Deng D, Frederick T
Perceived value of the electronic health record and its association with physician burnout.
The objective of this study was to investigate how seniority/years of practice, gender, and screened burnout status were associated with opinions of electronic health record (EHR) use on quality, cost, and efficiency of care. Ambulatory primary care and subspecialty clinicians at three different institutions were surveyed. Findings showed that burnout status was significantly associated with clinicians' perceived value of EHR technologies, while years of practice and gender were not.
AHRQ-funded; HS022065.
Citation: Livaudais M, Deng D, Frederick T .
Perceived value of the electronic health record and its association with physician burnout.
Appl Clin Inform 2022 Aug;13(4):778-84. doi: 10.1055/s-0042-1755372..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Burnout, Provider: Physician
Wang X, Blumenthal HJ, Hoffman D
Modeling patient-related workload in the emergency department using electronic health record data.
Understanding and managing clinician workload is important for clinician (nurses, physicians and advanced practice providers) occupational health as well as patient safety. Efforts have been made to develop strategies for managing clinician workload by improving patient assignment. The goal of the current study was to use electronic health record (EHR) data to predict the amount of work that individual patients contributed to clinician workload (patient-related workload).
AHRQ-funded; HS022542.
Citation: Wang X, Blumenthal HJ, Hoffman D .
Modeling patient-related workload in the emergency department using electronic health record data.
Int J Med Inform 2021 Jun;150:104451. doi: 10.1016/j.ijmedinf.2021.104451..
Keywords: Emergency Department, Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Physician
Dymek C, Kim B, Melton GB
AHRQ Author: Dymek C, Hsiao CJ
Building the evidence-base to reduce electronic health record-related clinician burden.
This paper looks at the evidence-base to reduce electronic health record-related (EHR-related) clinician burden. Evidence-based informatics approaches, pragmatic next steps, and future research directions are presented to improve three of the highest contributors to EHR burden: documentation, chart review, and inbox tasks. Perspectives are also offered on how EHR vendors, healthcare system leaders, and policymakers can play an integral role to make EHR easier to use.
AHRQ-authored; AHRQ-funded; HS027363.
Citation: Dymek C, Kim B, Melton GB .
Building the evidence-base to reduce electronic health record-related clinician burden.
J Am Med Inform Assoc 2021 Apr 23;28(5):1057-61. doi: 10.1093/jamia/ocaa238..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Burnout, Evidence-Based Practice, Provider: Clinician, Provider: Physician, Provider
Blackley SV, Schubert VD, Goss FR
Physician use of speech recognition versus typing in clinical documentation: a controlled observational study.
Researchers studied the usability and quality of documentation with speech recognition (SR) versus typing; participants were ten physicians at Brigham and Women's Hospital, Boston, who had used SR for at least six months. The researchers found that participants felt that SR saved them time, increased their efficiency, and allowed them to quickly document more relevant details. Quality analysis supported the perception that SR allowed for more detailed notes, but whether dictation was objectively faster than typing remains unclear, and participants described some scenarios where typing was still preferred. They concluded that dictation can be effective for creating comprehensive documentation, especially when physicians like and feel comfortable using SR.
AHRQ-funded; HS024264.
Citation: Blackley SV, Schubert VD, Goss FR .
Physician use of speech recognition versus typing in clinical documentation: a controlled observational study.
Int J Med Inform 2020 Sep;141:104178. doi: 10.1016/j.ijmedinf.2020.104178.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Physician, Provider
Adler-Milstein J, Zhao W, Willard-Grace R
Electronic health records and burnout: time spent on the electronic health record after hours and message volume associated with exhaustion but not with cynicism among primary care clinicians
This study examined whether objective measures of electronic health record (EHR) use-related to time, volume of work, and proficiency are associated with either exhaustion or cynicism. The authors combined Maslach Burnout Inventory survey measures with objective, vendor-defined EHR use measures from log files. Data was collected from all primary care clinics of a large, urban medical academic center in early 2018. One-third of clinicians had high cynicism and 51% had high emotional exhaustion. The clinicians with the most exhaustion spent time using the EHR after hours.
AHRQ-funded; HS022241.
Citation: Adler-Milstein J, Zhao W, Willard-Grace R .
Electronic health records and burnout: time spent on the electronic health record after hours and message volume associated with exhaustion but not with cynicism among primary care clinicians
J Am Med Inform Assoc 2020 Apr;27(4):531-38. doi: 10.1093/jamia/ocz220..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Burnout, Provider: Clinician, Provider: Physician, Provider, Primary Care
Sieck CJ, Pearl N, Bright TJ
A qualitative study of physician perspectives on adaptation to electronic health records.
their use has increased in the last decade. Because of this, acceptance and adoption of EHRs is less of a concern than adaptation to use. To understand this issue more deeply, the investigators conducted a qualitative study of physician perspectives on EHR use to identify factors that facilitate adaptation.
AHRQ-funded; HS024767.
Citation: Sieck CJ, Pearl N, Bright TJ .
A qualitative study of physician perspectives on adaptation to electronic health records.
BMC Med Inform Decis Mak 2020 Feb 10;20(1):25. doi: 10.1186/s12911-020-1030-6..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Physician, Provider
Gomes KM, Ratwani RM
Evaluating improvements and shortcomings in clinician satisfaction with electronic health record usability.
In this research letter, the authors studied usability of electronic health records (EHR) with the system usability scale (SUS). They found that SUS scores decreased for 44% of vendors. Clinician satisfaction with EHR usability is not improving for many widely used products, and the authors recommended increased focus on clinician end users during product design and development as well as optimized certification requirements in order to improve usability.
AHRQ-funded; HS025136.
Citation: Gomes KM, Ratwani RM .
Evaluating improvements and shortcomings in clinician satisfaction with electronic health record usability.
JAMA Netw Open 2019 Dec 2;2(12):e1916651. doi: 10.1001/jamanetworkopen.2019.16651..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Clinician, Provider: Physician, Provider
Chan B, Lyles C, Kaplan C
A comparison of electronic patient-portal use among patients with resident and attending primary care providers.
In this study, the authors investigated differences in overall and patterns of portal use for patients with resident and attending primary care providers (PCPs). They concluded that given the lower patient-portal use among residents' patients, residency programs should develop curricula to bolster trainee competence in using the patient-portal for communication and to enhance the patient-physician relationship.
AHRQ-funded; HS022981; HS022408.
Citation: Chan B, Lyles C, Kaplan C .
A comparison of electronic patient-portal use among patients with resident and attending primary care providers.
J Gen Intern Med 2018 Dec;33(12):2085-91. doi: 10.1007/s11606-018-4637-x..
Keywords: Clinician-Patient Communication, Education: Continuing Medical Education, Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care, Provider, Provider: Physician
Everson J, Richards MR, Buntin MB
Horizontal and vertical integration's role in meaningful use attestation over time.
This study examined rates of attestation and attrition from the meaningful use (MU) program by independent, horizontally integrated, and vertically integrated physicians. The goal was to determine if MU created pressure for independent physicians to join integrated organizations. They compared attestation rates using secondary data from SK&A and Medicare MU Files from 2011-2016 with office-based physicians. The sample size was 291,234 physicians. Forty-nine percent of physicians that remained independent during the period attested to MU at least once during the program, compared with 70% that remained horizontally or vertically integrated. There was also significantly more attrition among independent physicians than those physicians who were integrated.
AHRQ-funded; HS026395.
Citation: Everson J, Richards MR, Buntin MB .
Horizontal and vertical integration's role in meaningful use attestation over time.
Health Serv Res 2019 Oct;54(5):1075-83. doi: 10.1111/1475-6773.13193..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Workforce, Provider: Physician, Provider, Medicare
Zikmund-Fisher BJ, Solomon JB, Scherer AM
Primary care providers' preferences and concerns regarding specific visual displays for returning hemoglobin A1c test results to patients.
Patient portals of electronic health record systems currently present patients with tables of laboratory test results, but visual displays can increase patient understanding and sensitivity to result variations. In this study, the investigators sought to assess physician preferences and concerns about visual display designs as potential motivators or barriers to their implementation.
Citation: Zikmund-Fisher BJ, Solomon JB, Scherer AM .
Primary care providers' preferences and concerns regarding specific visual displays for returning hemoglobin A1c test results to patients.
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Keywords: Primary Care, Electronic Health Records (EHRs), Education: Patient and Caregiver, Health Information Technology (HIT), Provider: Clinician, Provider: Physician, Provider
Hultman GM, Marquard JL, Kandaswamy S
Electronic progress note reading patterns: an eye tracking analysis.
This study used eye-tracking to understand how the order of note sections influences the way physicians read electronic progress notes. Results showed no relationship between time spent reading a section and section origin of verbal summaries.
AHRQ-funded; HS022085.
Citation: Hultman GM, Marquard JL, Kandaswamy S .
Electronic progress note reading patterns: an eye tracking analysis.
Stud Health Technol Inform 2019 Aug 21;264:1684-85. doi: 10.3233/shti190596..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Provider, Provider: Physician
Kroth PJ, Morioka-Douglas N, Veres S
Association of electronic health record design and use factors with clinician stress and burnout.
The authors sought to determine which electronic health record (EHR) design and use factors are associated with clinician stress and burnout and to identify other sources that contribute to this problem. Surveying ambulatory primary care and subspecialty clinicians from 3 institutions, they found that, although EHR design and use factors are associated with clinician stress and burnout, other challenges, such as chaotic clinic atmospheres and workload control, explain considerably more of the variance in these adverse clinician outcomes.
AHRQ-funded; HS022065.
Citation: Kroth PJ, Morioka-Douglas N, Veres S .
Association of electronic health record design and use factors with clinician stress and burnout.
JAMA Netw Open 2019 Aug 2;2(8):e199609. doi: 10.1001/jamanetworkopen.2019.9609..
Keywords: Burnout, Stress, Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care, Provider: Clinician, Provider: Physician, Provider: Nurse
Hultman GM, Marquard JL, Lindemann E
Challenges and opportunities to improve the clinician experience reviewing electronic progress notes.
There is a need to understand better how clinicians review electronic notes and how note structure variability may impact clinicians' note-reviewing experiences. This article aimed to understand how physicians review electronic clinical notes and what impact section order has on note-reviewing patterns. The investigators indicated that their findings support the need to improve EHR note design and presentation to support optimal note review patterns for clinicians.
AHRQ-funded; HS022085.
Citation: Hultman GM, Marquard JL, Lindemann E .
Challenges and opportunities to improve the clinician experience reviewing electronic progress notes.
Appl Clin Inform 2019 May;10(3):446-53. doi: 10.1055/s-0039-1692164..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Physician, Provider
Mazur LM, Mosaly PR, Moore C
Association of the usability of electronic health records with cognitive workload and performance levels among physicians.
This research studied the association between the usability of electronic health records (EHRs) and cognitive workload and performance levels among physicians. Current EHRs have problems dealing with patients who had abnormally managed test results due to not appearing for their scheduled follow-up evaluation. Performance and cognitive workload were both quantified with 38 physicians, with 25 (66%) of them female.
AHRQ-funded; HS024062.
Citation: Mazur LM, Mosaly PR, Moore C .
Association of the usability of electronic health records with cognitive workload and performance levels among physicians.
JAMA Netw Open 2019 Apr 5;2(4):e191709. doi: 10.1001/jamanetworkopen.2019.1709..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Physician
Hose BZ, Hoonakker PLT, Wooldrige AR
Physician perceptions of the electronic problem list in pediatric trauma care.
Researchers described physician perceptions of the potential goals, characteristics, and content of the electronic problem list (PL) in pediatric trauma. They identified five goals of the PL, seven characteristics, and 22 patient-related information elements. They found that physicians involved in pediatric trauma care described the electronic PL as ideally more than a list of a patient's medical diagnoses and injuries. They recommend future work to evaluate the optimal design of the PL so that users with emergent cases have access to key information related to the patient's immediate problems.
AHRQ-funded; HS023837.
Citation: Hose BZ, Hoonakker PLT, Wooldrige AR .
Physician perceptions of the electronic problem list in pediatric trauma care.
Appl Clin Inform 2019 Jan;10(1):113-22. doi: 10.1055/s-0039-1677737..
Keywords: Children/Adolescents, Electronic Health Records (EHRs), Health Information Technology (HIT), Trauma, Provider: Physician, Provider
Lybarger KJ, Ostendorf M, Riskin E
Asynchronous speech recognition affects physician editing of notes.
Clinician progress notes are an important record for care and communication, but there is a perception that electronic notes take too long to write and may not accurately reflect the patient encounter, threatening quality of care. Automatic speech recognition (ASR) has the potential to improve clinical documentation process; however, ASR inaccuracy and editing time are barriers to wider use. In this study, the investigators hypothesized that automatic text processing technologies could decrease editing time and improve note quality.
AHRQ-funded; HS023631.
Citation: Lybarger KJ, Ostendorf M, Riskin E .
Asynchronous speech recognition affects physician editing of notes.
Appl Clin Inform 2018 Oct;9(4):782-90. doi: 10.1055/s-0038-1673417..
Keywords: Provider: Physician, Provider, Electronic Health Records (EHRs), Health Information Technology (HIT)
Denton CA, Soni HC, Kannampallil TG
Emergency physicians' perceived influence of EHR use on clinical workflow and performance metrics.
In this article, the authors investigated the perceived effects of electronic health record (EHR) use on clinical workflow and meaningful use (MU) performance metrics. The investigators concluded that physicians' perception of EHRs was likely to influence their practices. They suggested that with negative perceptions of EHR usability problems, positive aspects of EHR use, including the influence on MU performance metrics, may be overridden.
AHRQ-funded; HS022670.
Citation: Denton CA, Soni HC, Kannampallil TG .
Emergency physicians' perceived influence of EHR use on clinical workflow and performance metrics.
Appl Clin Inform 2018 Jul;9(3):725-33. doi: 10.1055/s-0038-1668553..
Keywords: Electronic Health Records (EHRs), Emergency Department, Health Information Technology (HIT), Workflow, Provider: Physician, Provider
Kannampallil TG, Denton CA, Shapiro JS
Efficiency of emergency physicians: insights from an observational study using EHR log files.
The authors investigated the nature of electronic health records use and their effect on an emergency department's throughput and efficiency. They found that longer time spent on reviewing information on the electronic health record is potentially associated with decreased emergency department throughput efficiency. The authors also note that balancing between these competing goals is a challenge for physicians, and implications for patient safety are discussed.
AHRQ-funded; HS022670.
Citation: Kannampallil TG, Denton CA, Shapiro JS .
Efficiency of emergency physicians: insights from an observational study using EHR log files.
Appl Clin Inform 2018 Jan;9(1):99-104. doi: 10.1055/s-0037-1621705..
Keywords: Electronic Health Records (EHRs), Emergency Department, Healthcare Delivery, Health Information Technology (HIT), Provider, Provider: Physician
Ancker JS, Edwards A, Nosal S
Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system.
In this study, the investigators tested hypotheses arising from two possible alert fatigue mechanisms: (A) cognitive overload associated with amount of work, complexity of work, and effort distinguishing informative from uninformative alerts, and (B) desensitization from repeated exposure to the same alert over time. The investigators found that clinicians became less likely to accept alerts as they received more of them, particularly more repeated alerts. There was no evidence of an effect of workload per se, or of desensitization over time for a newly deployed alert.
AHRQ-funded; HS021531.
Citation: Ancker JS, Edwards A, Nosal S .
Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system.
BMC Med Inform Decis Mak 2017 Apr 10;17(1):1-9. doi: 10.1186/s12911-017-0430-8..
Keywords: Clinical Decision Support (CDS), Decision Making, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety, Provider, Provider: Nurse, Provider: Physician
Revere D, Hills RH, Dixon BE
Notifiable condition reporting practices: implications for public health agency participation in a health information exchange.
The researchers sought to better understand the barriers to and burden of notifiable condition reporting from the perspectives of clinic physicians, interviews with clinic reporters, and interviews with public health workers involved in reporting workflow. A strong recommendation generated by their findings is that, given their central role in reporting, clinic reporters are a significant target audience for public health outreach and education that aims to alleviate perceived reporting burden and improve reporting knowledge.
AHRQ-funded; HS020909.
Citation: Revere D, Hills RH, Dixon BE .
Notifiable condition reporting practices: implications for public health agency participation in a health information exchange.
BMC Public Health 2017 Mar 11;17(1):247. doi: 10.1186/s12889-017-4156-4.
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Keywords: Health Information Exchange (HIE), Public Health, Infectious Diseases, Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Physician, Provider: Clinician, Provider
Abramson EL, Patel V, Pfoh ER
How physician perspectives on E-prescribing evolve over time. a case study following the transition between EHRs in an outpatient clinic.
The study objective was to examine how perceptions about using the new electronic health record (EHR) evolved over time, with focus on electronic prescribing. It found that for even experienced e-prescribers, achieving prior levels of perceived prescribing efficiency took nearly two years. Despite the fact that speed in performing prescribing-related tasks was highly important, most were still not utilizing system short cuts or customization features designed to maximize efficiency.
AHRQ-funded; R18 HS017029.
Citation: Abramson EL, Patel V, Pfoh ER .
How physician perspectives on E-prescribing evolve over time. a case study following the transition between EHRs in an outpatient clinic.
Appl Clin Inform 2016 Oct 26;7(4):994-1006. doi: 10.4338/aci-2016-04-ra-0069.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Physician, Provider
Babbott S, Manwell LB, Brown R
Electronic medical records and physician stress in primary care: results from the MEMO Study.
In this paper, the investigators assessed relationships between the number of EMR functions, primary care work conditions, and physician satisfaction, stress and burnout. The authors concluded that stress may rise for physicians with a moderate number of EMR functions; they found that time pressure was associated with poor physician outcomes mainly in the high EMR cluster.
AHRQ-funded; HS011955.
Citation: Babbott S, Manwell LB, Brown R .
Electronic medical records and physician stress in primary care: results from the MEMO Study.
J Am Med Inform Assoc 2014 Feb;21(e1):e100-6. doi: 10.1136/amiajnl-2013-001875..
Keywords: Burnout, Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care, Provider: Clinician, Provider: Physician