Clinicians' perceptions of usability of an electronic medical record over time

Abstract

The study evaluated clinicians' usability perceptions of an electronic medical record (EMR) over time in a large east coast research medical center. The descriptive retrospective longitudinal design used secondary data obtained from a performance measurement plan. Electronic survey data were collected at five different points in time over four years. The anonymous responses made matching of the 1148 individuals impossible so thirty cases were defined grouping clinicians by age category, gender, and role. Each response was considered to be a repetition of measurement of the case. The research questions explored the overall patterns of change in usability related to an EMR implementation, the short term and long term change in usability, and if the patterns of usability were influenced by frequency of use, gender, age, length of service (LOS), or role. The short term impact included evaluations at baseline, four months, and 16 months after the implementation of an EMR. The long term impact included evaluations before, four months, and 16 months following a system upgrade. Linear mixed model analysis was used to examine patterns of change over time including the contribution of frequency of use and user characteristics on the outcome variables. Each variable had curvilinear and linear patterns following the initial EMR implementation but not after the system upgrade. Usefulness, ease of use, supports clinical care, and supports research had significant linear and/or quadratic changes over the short term but no significant changes in long term except for ease of use. Frequency of use was a significant predictor for usefulness and supports clinical care but not for ease of use. Age, LOS, and role contributed significantly to usefulness, ease of use and supports clinical care but gender did not. Role and LOS combined were significant predictors for usefulness, supports clinical care, and ease of use over the short term. The findings indicate significant short term changes related to the initial EMR implementation but not the upgrade. This had implications for system development related to education, clinical practice and research.