Comparing Perceptions and Use of a Commercial Electronic Medical Record (EMR) between Primary Care and Subspecialty Physicians

Introduction

Electronic medical records (EMRs) are gaining increasing prominence in the delivery of healthcare¹ although the focus is primarily on deploying EMRs. Relatively little research has studied the post-implementation of commercial EMRs². Here we present the results of a web-based survey comparing primary care providers (PCPs) and sub-specialists (SSs) in our tertiary care health system. The respondent demographics and their perception, use, and training in an EMR environment, five year after its initial deployment throughout our healthcare environment.

Methods

We have had the EpicCare EMR by Epic Systems Incorporated (currently using Hyperspace Summer 2004 version) in our tertiary care, university affiliated hospital since 1999. In January and February of 2005, we developed a web-based survey for all primary care providers in internal medicine, pediatrics, family medicine, and internal medicine-pediatrics, and sub-specialists in internal medicine, pediatrics, and family medicine. The demographic, perception, use, and training responses between PCPs and sub-specialists were compared using independent sample t-tests and chi-square tests for continuous and categorical variables respectively.

Results

A total of 84 providers (59 PCPs and 25 SSs) were surveyed. The survey response rate was 55% (84 of 154). Demographic characteristics of respondents appear in Table 1.

Table 1.

Demographic information.

Characteristic	Mean (std dev)		p-value
	PCPs	SSs
Age	43 (8)	50 (11)	<0.01*
Years in practice	15 (9)	23 (11)	<0.01*
Years w/EMR	4 (1)	3 (1)	<0.01*
% clinic practice	80% (23)	53 (29)	0.01*

^*statistically significant

In the area of training, 46% of PCPs and 43% of SSs (p=0.36) felt that their initial training was adequate and majority of PCPs (75%) and SSs (81%) (p=0.58) felt that they would benefit from additional training. Forty-seven (47) percent of PCPs, but only 26% of SSs (p=0.09) would participate in an EMR Physician Users’ Group if given the chance.

Table 2 shows differences in EMR perception between PCPs and SSs.

Table 2.

EMR perceptions.

Characteristic of EMR	PCPs	SSs	p-value
Better patient care	87%	52%	<0.01*
Better then paper record	82%	52%	0.02*
Improved billing	78%	67%	0.32

^*statistically significant

Table 3 depicts the use of EMR functions and the extent to which EMR features, including best practice flags and medication interaction alerts, changed clinical practice.

Table 3.

EMR use (italics indicates higher number.

EMR Function	% use/change practice		p-value
	PCP	SS	SS
SmartPhrase/Text	77%	77%	0.92
Medication lists	61%	67%	0.56
Problem lists	56%	43%	0.12
History fields	40%	34%	0.48
SmartForm	34%	32%	0.82
Patient handouts	28%	8%	<0.01*
Best practice flag	16%	19%	0.60
Medication alert	12%	15%	0.56

^*statistically significant

Conclusions

This study shows that in a mature EMR environment, differences exist between primary and subspecialty providers in their perceptions and use of an EMR. This has important implications for deployment of EMR’s throughout the US health care system in which many different types of physicians practice. Therefore, different approaches may need to be developed for adoption and utilization of EMR’s among primary care and subspecialty physicians.