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Appl Clin Inform 2023; 14(02): 279-289
DOI: 10.1055/s-0043-1763513
Research Article

Electronic Health Record Use and Perceptions among Urologic Surgeons

Hung-Jui Tan
1   Department of Urology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
2   Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
,
Arlene E. Chung
3   Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, United States
,
David Gotz
2   Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
4   School of Information and Library Science, University of North Carolina, Chapel Hill, North Carolina, United States
,
Allison M. Deal
2   Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
,
Hillary M. Heiling
2   Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
,
Randall Teal
2   Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
5   Connected Health Applications and Interventions Core, University of North Carolina, Chapel Hill, North Carolina, United States
,
Maihan B. Vu
5   Connected Health Applications and Interventions Core, University of North Carolina, Chapel Hill, North Carolina, United States
6   Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, North Carolina, United States
,
William D. Meeks
7   Data Management and Statistical Analysis, American Urological Association, Linthicum, Maryland, United States
,
Raymond Fang
7   Data Management and Statistical Analysis, American Urological Association, Linthicum, Maryland, United States
,
Antonia V. Bennett
2   Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
8   Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States
,
Matthew E. Nielsen
1   Department of Urology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
2   Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
8   Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States
,
Ethan Basch
2   Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
8   Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States
9   Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
› Institutsangaben Funding H.-J. T., MD, MSHPM was supported by a Mentored Research Scholar Grant in Applied and Clinical Research, MRSG-18-193-01-CPPB, from the American Cancer Society as well as the NIH Loan Repayment Program. The national survey was conducted through the American Urological Association (AUA) with approval and support from the AUA Data Committee and the AUA Data Management and Statistical Analysis team. The qualitative interviews were conducted through UNC CHAI Core, which receives funding support from National Cancer Institute grant P30-CA16086 to the UNC Lineberger Comprehensive Cancer Center.
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Abstract

Objective Electronic health records (EHRs) have become widely adopted with increasing emphasis on improving care delivery. Improvements in surgery may be limited by specialty-specific issues that impact EHR usability and engagement. Accordingly, we examined EHR use and perceptions in urology, a diverse surgical specialty.

Methods We conducted a national, sequential explanatory mixed methods study. Through the 2019 American Urological Association Census, we surveyed urologic surgeons on EHR use and perceptions and then identified associated characteristics through bivariable and multivariable analyses. Using purposeful sampling, we interviewed 25 urologists and applied coding-based thematic analysis, which was then integrated with survey findings.

Results Among 2,159 practicing urologic surgeons, 2,081 (96.4%) reported using an EHR. In the weighted sample (n = 12,366), over 90% used the EHR for charting, viewing results, and order entry with most using information exchange functions (59.0–79.6%). In contrast, only 35.8% felt the EHR increases clinical efficiency, whereas 43.1% agreed it improves patient care, which related thematically to information management, administrative burden, patient safety, and patient–surgeon interaction. Quantitatively and qualitatively, use and perceptions differed by years in practice and practice type with more use and better perceptions among more recent entrants into the urologic workforce and those in academic/multispecialty practices, who may have earlier EHR exposure, better infrastructure, and more support.

Conclusion Despite wide and substantive usage, EHRs engender mixed feelings, especially among longer-practicing surgeons and those in lower-resourced settings (e.g., smaller and private practices). Beyond reducing administrative burden and simplifying information management, efforts to improve care delivery through the EHR should focus on surgeon engagement, particularly in the community, to boost implementation and user experience.

Keywords

electronic health records - satisfaction - usability - user experience - practice setting

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects. It was reviewed by UNC Institutional Review Board. The study did not involve any animal subjects.




Publikationsverlauf

Eingereicht: 26. August 2022

Angenommen: 19. Januar 2023

Artikel online veröffentlicht:
12. April 2023

© 2023. Thieme. All rights reserved.

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