Patient safety perceptions of primary care providers after implementation of an electronic medical record system

Abstract

Background: Increasing the use of electronic medical records (EMR) has been suggested as an important strategy for improving healthcare safety.

Objective: To sequentially measure, evaluate, and respond to safety culture and practice safety concerns following EMR implementation.

Design: Safety culture was assessed using a validated tool (Safety Attitudes Questionnaire; SAQ), immediately following EMR implementation (T1) and at 1.5 (T2) and 2.5 (T3) years post-implementation. The SAQ was supplemented with a practice-specific assessment tool to identify safety needs and barriers.

Participants: A large medical group practice with a primary care core of 17-18 practices, staffed by clinicians in family medicine, pediatrics, internal medicine.

Interventions: Survey results were used to define and respond to areas of need between assessments with system changes and educational programs.

Main measures: Change in safety culture over time; perceived impact of EMR on practice.

Key results: Responses were received from 103 of 123 primary care providers in T1 (83.7 % response rate), 122 of 143 in T2 (85.3 %) and 142 of 181 in T3 (78.5 %). Safety culture improved over this period, with statistically significant improvement in all domains except for stress recognition. Time constraints, communications and patient adherence were perceived to be the most important safety issues. The majority of respondents in both T2 (77.9 %) and T3 (85.4 %) surveys agreed that the EMR improved their ability to provide care more safely.

Conclusions: Implementation of an EMR in a large primary care practice required redesign of many organizational processes, and was associated with improvements in safety culture. Most primary care providers agreed that the EMR allowed them to provide care more safely.

Figure 1.

Comparison of safety culture by domain for primary care providers after EMR implementation. Safety culture domains were assessed by SAQ response among primary care providers immediately following EMR implementation (T1), 1.5 years after implementation (T2) and approximately 2.5 years after implementation (T3). Chi squared analysis is shown for T1 vs. T3, (*T2 vs. T3) and shows significant improvements (P < 0.05) in domains other than stress recognition.