Information System Experience, Extended Use, And Efficiency: A Quantitative Analysis Of Individual Electronic Health Record Use

Abstract

Implementing an Electronic Health Record (EHR) system is a costly and complex organizational endeavor that may result in users, particularly physicians, using the EHR’s rich features in a limited manner. The goal of EHR implementation is to move beyond limited, mandatory use towards the full extended and productive use of the EHR system to realize the full scope of benefits. To realize these benefits, users must utilize an EHR effectively; this is challenging due to the time and effortrequired to document patient encounters in an electronic system. Utilizing an organizational learning perspective and theorizing around extended use for EHRs, this study investigates how EHR System Use Experience may affect EHR Task Length for physicians, how EHR Extended Use is influenced by EHR System Use Experience, and in turn how EHR Extended Use may affect EHR Task Length. This study utilizes a longitudinal dataset of individual EHR use metrics (e.g., EHR features used, navigation clicks, time spent documenting) accumulated during the four-year rollout of an EHR system across a network of military hospitals and clinics. This study will utilize a combination of statistical approaches including correlation, factor analysis, t-tests, linear regression and structural equation modeling to investigate these relationships. Utilizing a large data set of actual system log data in this analysis, this study indicates that as EHR System Use Experience (measured as months of use and cumulative patients seen) increases, EHR Task Length (measured as time in EHR and time spent documenting) decreases. Empirical analyses also indicate that EHR Extended Use increases with experience, contributing to a modest increase in task length. Comparative analyses of EHR user experience for physicians vs. nurses and students, in clinics vs. hospitals, for earlier adopters vs. later adopters, and for the subset of advanced users vs. basic users of the EHR highlight nuances in these relationships. The study informs practice by demonstrating how to identify extended users, how to develop additional organizational and usage insights from system-generated performance metrics, and how to better assess the potential return on investment on an electronic health record system.