ArticleAnnals of family medicine
Gradual electronic health record implementation: new insights on physician and patient adaptation.
Article in Annals of family medicine. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
27 citing papers in PubMed, 4 syntheses or guidelines pooled it, 88 citations in OpenAlex.
- Characterizing Behaviors That Influence the Implementation of Digital-Based Interventions in Health Care: Systematic Review.Journal of medical Internet research · 2025Pooled it
- The impact of eHealth use on general practice workload in the pre-COVID-19 era: a systematic review.BMC health services research · 2024Pooled it
- Developing an evidence base of best practices for integrating computerized systems into the exam room: a systematic review.Journal of the American Medical Informatics Association : JAMIA · 2017Pooled it
- Impact of Electronic Medical Record Use on the Patient-Doctor Relationship and Communication: A Systematic Review.Journal of general internal medicine · 2016Pooled it
- 25 Years of Electronic Health Record Implementation Processes: Scoping Review.Journal of medical Internet research · 2025Article
- Electronic health records perception among three healthcare providers specialties in Saudi Arabia: A cross-sectional study.Healthcare technology letters · 2023Article
- The Integrated Electronic Health System in Iranian health centers: benefits and challenges.BMC primary care · 2023Article
- Examining How Internet Users Trust and Access Electronic Health Record Patient Portals: Survey Study.JMIR human factors · 2021Article
- Caring for Computers: The Hidden Work of Clinical Nurses during the Introduction of Health Information Systems in a Teaching Hospital in Taiwan.Nursing reports (Pavia, Italy) · 2021Article
- Exploring association between certified EHRs adoption and patient experience in U.S. psychiatric hospitals.PloS one · 2020Article
- The complex case of EHRs: examining the factors impacting the EHR user experience.Journal of the American Medical Informatics Association : JAMIA · 2019Article
- Clinically Excellent Use of the Electronic Health Record: Review.JMIR human factors · 2018Review
- "A palliative end-stage COPD patient does not exist": a qualitative study of barriers to and facilitators for early integration of palliative home care for end-stage COPD.NPJ primary care respiratory medicine · 2018Article
- Towards a Clinical Trial Protocol to Evaluate Health Information Systems: Evaluation of a Computerized System for Monitoring Tuberculosis from a Patient Perspective in Brazil.Journal of medical systems · 2018Article
- Investigation of the Use of a Family Health History Application in Genetic Counseling.Journal of genetic counseling · 2018Article
- Learning to use electronic health records: can we stay patient-centered? A pre-post intervention study with family medicine residents.BMC family practice · 2017Article
- Patients' support for health information exchange: a literature review and classification of key factors.BMC medical informatics and decision making · 2017Review
- Computers in the clinical encounter: a scoping review and thematic analysis.Journal of the American Medical Informatics Association : JAMIA · 2016Article
- Electronic Health Record Use a Bitter Pill for Many Physicians.Perspectives in health information managemen · 2016Article
- Strategizing EHR use to achieve patient-centered care in exam rooms: a qualitative study on primary care providers.Journal of the American Medical Informatics Association : JAMIA · 2016Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 2 institutions in 1 country.
Funding
Abstract
purposeAlthough there is significant interest in implementation of electronic health records (EHRs), limited data have been published in the United States about how physicians, staff, and patients adapt to this implementation process. The purpose of this research was to examine the effects of EHR implementation, especially regarding physician-patient communication and behaviors and patients' responses.
methodsWe undertook a 22-month, triangulation design, mixed methods study of gradual EHR implementation in a residency-based family medicine outpatient center. Data collection included participant observation and time measurements of 170 clinical encounters, patient exit interviews, focus groups with nurses, nurse's aides, and office staff, and unstructured observations and interviews with nursing staff and physicians. Analysis involved iterative immersion-crystallization discussion and searches for alternate hypotheses.
resultsPatient trust in the physician and security in the physician-patient relationship appeared to override most patients' concerns about information technology. Overall, staff concerns about potential deleterious consequences of EHR implementation were dispelled, positive anticipated outcomes were realized, and unexpected benefits were found. Physicians appeared to become comfortable with the "third actor" in the room, and nursing and office staff resistance to EHR implementation was ameliorated with improved work efficiencies. Unexpected advantages included just-in-time improvements and decreased physician time out of the examination room.
conclusionsStrong patient trust in the physician-patient relationship was maintained and work flow improved with EHR implementation. Gradual EHR implementation may help support the development of beneficial physician and staff adaptations, while maintaining positive patient-physician relationships and fostering the sharing of medical information.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.