The impact of converting to an electronic health record on organizational culture and quality improvement

• HIT Description: HER More info...
  
• Purpose of Study: To examine changes in organization culture, quality improvement maturity and quality of care following adoption of EMR
  
• Years of study: 2003-2004
  
• Study Design: Time series
  
• Outcomes: Patient satisfaction, health care effectiveness and quality, organizational culture
  

• Settings: Nonprofit integrated health care system comprised of 3 hospitals, an employed physician medical group (with over 500 MDs), a research institute, and several outpatient clinics.
• Intervention: Installation of EHR.
• Evaluation Method: Used Culture and Quality Questionnaire (CQQ), Press-Ganey patient satisfaction survey, and quality measures in CHF, diabetes, and pneumonia.
• Description: EHR by Epic System, which incorporates 6 of the 8 IOM capabilities. EHR is available in the exam rooms of MD offices, at 6,000 terminals throughout 3 hospitals, and through remote access using SSL encryption and Secure ID.
• Strategy: Employees were not given a choice about whether or not to use the EHR. Mandatory training included competency tests. Will annually evaluate progress via quantitative study including 7 quality indicators and surveys of staff
• System Penetration: Use is mandatory; 100% of MDs, nurses, and other medical professionals now use.
• Facilitators: Mandated use, mandatory training
• Quality of Care and Patient Safety Outcome: 3 of the 7 quality indicators showed statistically significant changes (% of pneumonia patients receiving initial antibiotic dose within 4 hours of hospitalization, discharge of chest pain patients within 23 hours, and patient satisfaction scores ) all in the negative direction.
• Changes in efficiency and productivity: It is possible that learning a new system interfered with nurses' usual ways of providing care, leading to lower patient satisfaction. Contrary to expectation, employees perceived the organizational culture as becoming more, rather than less, hierarchical. Contrary to expectation, employees perceived the organizational culture as becoming more, rather than less, hierarchical.
• Time needed to accrue benefit: This article reports few benefits at one year. The authors believe that benefits will be seen in years 2 through 4.