Summary
Objective: Provide evidence-based advise to “Program of All-inclusive Care for the Elderly”
(PACE) decision makers considering implementing an electronic health record (EHR)
system, drawing on the results of a mixed methods study to examine: (1) the diffusion
of an EHR among clinicians documenting direct patient care in a PACE day care site,
(2) the impact of the use of the EHR on the satisfaction levels of clinicians, and
(3) the impact of the use of the EHR on patient functional outcomes.
Methods: Embedded mixed methods design with a post-test design quantitative experiment and
concurrent qualitative component. Quantitative methods included: (1) the EHR audit
log used to determine the frequency and timing during the week of clinicians’ usage
of the system; (2) a 22-item clinician satisfaction survey; and (3) a 16-item patient
functional outcome questionnaire related to locomotion, mobility, personal hygiene,
dressing, feeding as well the use of adaptive devices. Qualitative methods included
observations and open-ended, semi-structured follow-up interviews. Qualitative data
was merged with the quantitative data by comparing the findings along themes. The
setting was a PACE utilizing an EHR in Philadelphia: PACE manages the care of nursing-home
eligible members to enable them to avoid nursing home admission and reside in their
homes. Participants were 39 clinicians on the multi-disciplinary teams caring for
the elders and 338 PACE members.
Results: Clinicians did not use the system as intended, which may help to explain why the
benefits related to clinical processes and patient outcomes as expected for an EHR
were not reflected in the results. Clinicians were satisfied with the EHR, although
there was a non-significant decline between 11 and 17 months post implementation of
the EHR. There was no significant difference in patient functional outcome the two
time periods. However, the sample size of 48 was too small to allow any conclusive
statements to be made. Interpretation of findings underscores the importance of the
interaction of workflow and EHR functionality and usability to impact clinician satisfaction,
efficiency, and clinician use of the EHR.
Conclusion: This research provides insights into EHR use in the care of the older people in community-based
health care settings. This study assessed the adoption of an EHR outside the acute
hospital setting and in the community setting to provide evidence-based recommendations
to PACE decision makers considering implementing an EHR.
Keywords
Evaluation studies - technology evaluation - clinical information systems - patient
care team - aged