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Physician User Satisfaction with an Electronic Medical Records System in Primary Healthcare Centres in Al Ain: a Qualitative Study

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Physician User Satisfaction with an Electronic Medical Records System in Primary Healthcare Centres in Al Ain: a Qualitative Study Downloaded from http://bmjopen.bmj.com/ on November 14, 2015 - Published by group.bmj.com Open Access Research Physician user satisfaction with an electronic medical records system in primary healthcare centres in Al Ain: a qualitative study Shamma Al Alawi,1 Aysha Al Dhaheri,1 Durra Al Baloushi,1 Mouza Al Dhaheri,2 Engela A M Prinsloo3 To cite: Al Alawi S, Al ABSTRACT Strengths and limitations of this study Dhaheri A, Al Baloushi D, Objectives: To explore physician satisfaction with an et al. Physician user electronic medical records (EMR) system, to identify ▪ satisfaction with an electronic The electronic medical records (EMR) system and explore the main limitations of the system and medical records system in (Cerner) was introduced in the Emirate of Abu primary healthcare centres in finally to submit recommendations to address these Dhabi, but only Al Ain clinics were selected for Al Ain: a qualitative study. limitations. the study and, owing to the study design, the BMJ Open 2014;4:e005569. Design: A descriptive qualitative study that entailed findings cannot be generalised. doi:10.1136/bmjopen-2014- three focus group interviews was performed among ▪ This is the first local study to address EMR user 005569 physicians using open-ended questions. The interviews satisfaction adds a new user perspective. were audiotaped, documented and transcribed ▪ This study focused on the primary healthcare ▸ Prepublication history and verbatim. The themes were explored and analysed in physician EMR users excluding hospital users additional material is different categories. and related healthcare professionals. available. To view please visit Setting: The study was conducted in primary ▪ Method of focus-group recruitment contributed the journal (http://dx.doi.org/ healthcare centres (PHC) in Al Ain, United Arab to selection bias. 10.1136/bmjopen-2014- Emirates (UAE). 005569). Participants: A total of 23 physicians, all using the same EMR system, attended one of three focus groups Received 26 April 2014 INTRODUCTION Revised 7 October 2014 held in PHC in Al Ain Medical District. Each focus Accepted 17 October 2014 group consisted of 7–9 physicians working in PHC as The electronic medical record (EMR) is a family medicine specialists, residents or general new and promising tool for enhancing practitioners. national and international healthcare deliv- Primary outcome measure: Physician satisfaction ery.1 Recent research has shown that infor- with the EMR system. mation technologies can reduce medication Results: Key themes emerged and were categorised errors,2 improve adherence to clinical prac- as physician-dependent, patient-related and system- tice guidelines,3 and improve the delivery of related factors. In general, physicians were satisfied preventive health services,4 thereby poten- with the EMR system in spite of initial difficulties with tially improving health outcomes for implementation. Most participants identified that the patients.56While electronic medical users long time required to do the documentation affected 1Ambulatory Health Care their practice and patient communication. Many can be productive, any disparities in experi- Services, SEHA, Al Ain, Abu physicians expressed satisfaction with the orders and ence, understanding and skills can leave Dhabi, United Arab Emirates fi 2 results of laboratory and radiology functions and they team members feeling less than satis ed and Homecare Department, 1 Tawam Hospital in Affiliation emphasised that this was the strongest point in the not working to their full potential. with Johns Hopkins EMR. They were also satisfied with the electronic Clinicians’ perception of the EMR is a Medicine, Al Ain, Abu Dhabi, prescription function, stating that it reduced errors and crucial determinant of the successful use of United Arab Emirates saved time. 3 the EMR system. United Arab Emirate, Department of Family Conclusions: Physicians are satisfied with the EMR Health Authority of Abu-Dhabi (HAAD) has Medicine, College of and have a positive perception regarding the Medicine and Health implemented a system developed by one of application of the system. Several themes emerged Sciences UAE University, Al the top three Healthcare IT vendors in the Ain, Abu Dhabi, United Arab during this study that need to be considered to USA.6 They have been in existence since enhance the EMR system. Further studies need to be Emirates 1979 and have installations in many countries conducted among other healthcare practitioners and Correspondence to patients to explore their attitude and perception about including the USA, Canada, Australia, Saudi Dr Durra Al Baloushi; the EMR. Arabia, Qatar, UAE, France, Spain, [email protected] Singapore, Malaysia and South America. Al Alawi S, et al. BMJ Open 2014;4:e005569. doi:10.1136/bmjopen-2014-005569 1 Downloaded from http://bmjopen.bmj.com/ on November 14, 2015 - Published by group.bmj.com Open Access UAE has implemented the EMR system (Cerner) in conducted in the same PHC. To maximise ease of par- 2008 in Abu Dhabi and Al Ain. Information and ticipation, the interviews were held after office hours research studies related to user satisfaction is lacking in during lunchtime. We deliberately exempted the man- the local context. agerial representation from our focus groups. The main This research study focused on physician user satisfac- reason was that we were of the opinion that their pres- tion with the EMR system in primary healthcare centres ence would cause junior colleagues to feel uncomfort- (PHC) in Al Ain and was the first known survey con- able and prevent them from sharing their personal ducted in the UAE exploring this research question. experiences and perceptions on their use of the EMR in The findings of the quantitative study are reported in the workplace. separate paper. We conducted a concurrent qualitative The moderator introduced herself at the beginning of study in the same practices selected for the quantitative the focus groups, explaining the purpose of the study and project. assuring confidentiality of the information shared.8 The The use of focus group interviews is becoming increas- facilitator encouraged participation of all members in the ingly popular in healthcare research to explore the discussions using open-ended questions and prompts beliefs, feelings, attitudes and behaviour of individuals. focusing on the: (1) initial impression about the EMR Focus group discussions provide information about a system, (2) advantages and disadvantages of the EMR, (3) range of ideas and feelings of individuals about specific patients’ reaction to the introduction of the EMR and (4) issues and it illuminates the differences in perspective suggestions to improve the EMR. Interview questions were between groups of individuals. A focus group can gener- reviewed as the study progressed to seek further clarifica- ate a large amount of data in a relatively short time tions.9 See the online supplementary appendix A for span.7 detailed focus group questions. In this study, the researchers explored user knowledge, Focus group interviews were conducted on three con- attitude and satisfaction with the EMR system in PHC in secutive days. Each focus group interview lasted for an Al Ain. hour. Theme saturation was approximately achieved during the second focus group interview, and a third focus group interview was conducted to confirm the METHOD saturation. Study design This descriptive qualitative study was conducted in paral- lel with a quantitative study reported separately in a Data analysis paper presented at the 2nd Al Ain Family Medicine The interviews were audiotaped and transcribed verba- Research Day on 3 March 2012 at Al Ain, UAE. tim. As the interviews progressed, data were analysed after each focus group interview to develop preliminary codes to identify important and new ideas emerging. Study method Each transcript was independently reviewed and coded A purposive sampling strategy was used to recruit the separately by all the researchers to establish the main con- physicians.8 The study was conducted in English. cepts.1 Subsequently, each transcript was analysed by each Permission was obtained from the clinic supervisors of investigator independently to explore the themes and each hospital prior to the study. Invitation letters were subthemes and then reviewed by the other investigators distributed among the physicians in clinics where the to compare and group the similar data. Further relations quantitative study on the EMR system was conducted. and triangulations10 were analysed during regular meet- The management personnel were requested to select ings. The next stage involved identifying the theme frame the participants for our study. These workers were using the ‘Krueger’ framework.11 Trustworthiness of the selected based on their willingness to share their experi- data was enhanced by using Guba’s four criteria. 12 13 For ences on the EMR with us. Those who were to partici- more details see online supplementary appendix B. pate in the qualitative study were contacted by telephone 1–2 days before the focus group meeting. The physicians were not compensated for their time since Findings most of them were released during their shift hours. A total of 23 physicians attended one of the three focus The authors contributed to different aspects of the groups. The overall focus group attendance was 70–80%. research study. The third author, a family medicine resi- The main reason given for non-participation was lack of dent, reviewed the literature related to qualitative sufficient time. Each focus group consisted of 7–9 physi- research, received additional training related to qualita- cians working in the PHC as family medicine specialists, tive research methods, developed the moderators guide8 residents or general practitioners using the same EMR and moderated the focus groups. The three other system since 2008. The characteristics of the focus group researchers were respectively responsible for audiotaping participants are reported in table 1. and documenting verbal and non-verbal responses. Each focus group consisted of a mix of males and Participants signed a consent form before the focus females of different age groups and professional group session.
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