Impacts of Electronic Health Record Systems Applied to Healthcare Processes on Physician Performance - Research Proposal Example

Physicians’ Perception of the Impact of Electronic Health Records (EHRs) on their Work Performance: A Field Study in Riyadh, Saudi Arabia Research Proposal Name of Student Course Name Name of Professor Date of Submission General Overview of Area The adoption and implementation of the electronic health care records (EHRs) in Riyadh, Saudi Arabia significantly differ between the three tiers of the country’s entire health care sector: hospitals operated and owned by the Ministry of Health (MoH), government agency hospitals, and private hospitals. Such difference is partly caused by the perception of Saudi physicians of the impact of EHRs on their job performance. Based on the initial review of available studies, physicians in private and government-run hospitals are more open to the adoption and use of EHRs compared to physicians in MoH hospitals (Hasanain et al., 2014; Alkraiji et al., 2013; Almalki et al., 2011). Therefore, this study will attempt to determine how physicians from six hospitals in Saudi Arabia perceive the impact of the use of EHRs on their job performance. Two hospitals will be chosen from each of the three levels: 1st level: MoH-owned hospitals (King Saud Medical City in Riyadh and King Fahad Medical City in Riyadh) 2nd level: government agency hospitals (King Faisal Hospital & Research Center and National Guard Health Affairs in Riyadh) 3rd level: private hospitals (Dr. Sulaiman Al-Habib Takhassusi Hospital and Dallah Hospital). The researcher chooses to include all these three levels of Saudi Arabia’s health care sector in order to generate sufficient firsthand data for comparison. The proposed methods for gathering the needed information are questionnaire surveys and interviews. This area of study will fall under the disciplines of Health Services and Computer Sciences and Information Technology. The researcher has chosen this area of study because of experience and extensive background on the subject. The researcher worked as a medical record specialist. In addition, the researcher has a bachelor’s degree in Health Services management and hospital administration, as well as a master’s degree in Health and Hospital Administration wherein he carried out a research project on the impact of missed appointments at maternal health care clinics in primary health care centers in Riyadh, Saudi Arabia. This research project was accepted for publication in the Journal of Hospital Administration. Likewise, the researcher has completed a 6-month course in computer training with various computer software and applications.  Identification of the Relevant Literature An electronic health record (EHR) is a computerized form of patients’ written record. EHRs are digital, patient-focused records that provide instant and secure access to information. Although an EHR does hold patients’ clinical records, an EHR system is installed to go above usual medical information gathered in a healthcare professional’s office and can provide a wider perspective of patient care (Khalifa, 2013). EHRs are installed to make information accessible to other healthcare professionals and facilities, like workplace clinics, emergency facilities, pharmacies, and laboratories. When completely transferrable and operational, the advantages of an EHR system exceed those of the traditional paper documentation. In addition, an EHR system can boost cost efficiency and job performance; enhance care management; enhance health outcomes and precision of diagnoses; encourage the involvement of patients in their care; and raise convenience, accessibility, and quality of health care delivery (Almulhem, 2012). In general, the precise extent of nationwide implementation of EHRs in Saudi Arabia could not be identified from available literature. In 2008, Professor Majid Altuwaijri reported that for the past four decades, Saudi Arabia has generously invested in building and enhancing the quality of healthcare services and broadening its coverage (De Leon et al., 2010). Researches on MoH hospitals were more inclined to be carried out in specific areas and from such findings, it would seem that implementation of EHR has been minor and gradual. EHR implementation in private and military hospitals and in the National Guard Health Affair (NGHA) seems to be more intense and rapid, possibly due to factors such as smaller size, independence in decision making, and culture (Hasanain et al., 2014; Alkraiji et al., 2013; Almalki et al., 2011). Studies show that the reluctant acceptance of EHRs in MoH hospitals is caused by resource, social, and technical hindrances. It has been reported that the MoH has carried out several programs to install and enhance EHRs in its medical facilities. These programs are still in progress and implementation of a national integrated EHR system is a major goal of MoH in Saudi Arabia (Hasanain et al., 2014). Globally, studies on electronic health record systems have placed emphasis mainly on the attitude of physicians toward its application, which is associated with perception of system impact of electronic alerting systems on healthcare delivery and on documentation time. The adoption and implementation of EHR across the globe is different in developed and developing countries. According to available studies, it seems that developed countries are trying to redirect all their systems toward EHR. However, in developing countries, the main priority is to develop EHR as a supplement or backup to paper-based clinical records (Al-Jarullah & El-Masri, 2012). EHR adoption and implementation have been explored by Al-Aswad and colleagues (2013) and it seems that there is a number of developing and developed countries that use EHRs but fail to attain the targeted speed of distribution. For instance, a number of primary care physicians in Saudi Arabia still use old-style paper documentation to record and process medical information despite the known advantages of EHRs (Simon et al., 2009). A leading uncertainty among physicians is that the use of EHR will limit their productivity and thus lower their job performance. This uncertainty is not unfounded. Several studies discovered that physicians consume extra time and effort inputting information into the EHR, which, consequently, reduces the time they should spend with their patients and prolongs their work hours (Furukawa, 2011; Altuwaijri et al., 2012). Physicians are not opposed to technology but they are reluctant to use technologies that could hamper their workflow and could take away time from the process of delivering quality health care. In contrast, several physicians acknowledge the importance of EHRs and the quality enhancements attained (Blumenthal & Tavenner, 2010; Altuwaijri, 2011). However, even though physicians recognize the benefits of EHR systems, Ash and Bates (2005) claim that there is still a discrepancy between recognition of the benefits of EHRs and the actual use of the technology. It is thus vital to identify different factors which affect the use of EHRs by physicians. Physicians will regard the technology to be useful and productive if it is able to cut down time for documentation needed for patient care (Allan & Englebright, 2000; Poissant et al., 2005), whereas Miller and Sim (2004) hypothesized that physicians will boost their use of EHRs when it guarantees sufficient support, greater productivity, higher performance, and improved electronic data transaction. Simply put, ease of use and quick access to EHRs are a major motivation for physicians to adopt the technology. Hence, physicians preferred distant access to EHRs because it offers fast access to records and versatile work hours (Himmelstein & Woolhandler, 2005; Aanestada & Jensen, 2011). In summary, in spite of their benefits, numerous physicians are usually reluctant to adopt EHRs, and a major reason for such is that physicians believe that using EHRs will consume more of their time than paper-based clinical documentation. Therefore, the simplicity and quickness of use of an EHR is a major determining factor of how well it will be accepted and adopted by physicians (Anderson et al., 2006; Aldosari, 2012). Gaining knowledge of how EHRs could impact physicians’ performance will be vital in enhancing adoption and implementation of EHRs in major public and private hospitals in Saudi Arabia. Key Research Questions This research aims to examine the perception of physicians in six hospitals in Riyadh, Saudi Arabia on the impact of the adoption and implementation of EHRs on their job performance. This research will attempt to answer two major questions: (1) How do physicians in these six hospitals perceive the impact of electronic health records on their job performance? Do they view the use of electronic health records beneficial to their productivity or do they view it as an inferior substitute for paper-based medical records? (2) Is there a difference between the three levels of health care sector (MoH hospitals, government agency hospitals, and private hospitals) in Riyadh, Saudi Arabia in terms of physicians’ acceptance of EHRs? If there is, what are the causes of such difference? Methodology The study will employ questionnaire survey and interviews to collect data from randomly selected physicians in six hospitals in Riyadh, Saudi Arabia—two MoH hospitals, two government agency hospitals, and two private hospitals. The six hospitals are chosen in terms of size and level of EHR implementation. Two major hospitals in each of the three tiers are selected: King Saud Medical City, MoH hospital (Riyadh) King Fahad Medical City, MoH hospital (Riyadh) King Faisal Hospital & Research Center, government hospital (Riyadh) National Guard Health Affairs (NGHA), government hospital (Riyadh) Dr. Sulaiman Al-Habib Takhassusi Hospital, private hospital (Riyadh) Dallah Hospital, private hospital (Riyadh) This selection is also based on the 2014 survey of the University of Dammam and several current empirical studies (Hasanain et al., 2014; Alkraiji et al., 2013; Almalki et al., 2011), which identify high level of EHR integration in private hospitals and government agency hospitals, particularly in King Faisal Hospital & Research Center and NGHA, and low level of EHR infrastructure in MoH hospitals. This study will try to uncover the underlying reasons behind this disparity in the level of EHR implementation between MoH hospitals on the one hand and government agency hospitals and private hospitals on the other in Riyadh, Saudi Arabia. This qualitative research will use questionnaire surveys and interviews. This study will try to determine the main motivators behind EHR implementation in Riyadh, Saudi Arabia, how do physicians view the impact of the use of EHRs on their job performance. It will also examine the challenges confronted by physicians in using EHRs and potential strategies for overcoming them. Questionnaire surveys will be distributed to randomly selected physicians in the six hospitals in Riyadh, Saudi Arabia. The researcher will then interview the research participants. Some of the prospective questions for these interviews are: what difficulties have you experienced in using EHRs; do you think the use of EHR raised your productivity by, for instance, saving time making and processing clinical documents; do you think the benefits of EHRs outweigh its disadvantages? The interviews are expected to verify responses in the questionnaires. Two forms of interviews will be carried out for this study: informal conversational interviews will be carried out with IT managers to provide explanation of some findings that will be derived from physicians’ interviews; structured interviews will be carried out with physicians for they have limited time for the research. Timescale/Research Planning Year Project Goal Objective Activity Projected Duration of Completion 1 Writing of chapter 1 To gather all the necessary materials for the completion of chapter 1 Look for relevant materials, especially sources discussing the area of study 4 months Writing of chapter 2 To complete the review of related literature using the latest materials Look for latest references/studies about the area of study 8 months 2 Completion of data gathering To successfully distribute and gather questionnaire surveys Identify physicians that have the necessary background to answer the questionnaires and persuade them to take part in the study 6 months Completion of data gathering To successfully carry out the interviews with the selected participants Conduct the structured and informal interviews with the participants 6 months 3 Completion of data analysis To accurately manage survey data and code interview results Process results from the questionnaire survey and interviews; verification of results 10 months Completion of the Discussion and Conclusion sections To successfully sum up the outcomes of the research Thoroughly examine the process and outcomes of the study, then clearly discuss it and neatly summarize it 2 months Bibliography Aanestada, M. & Jensen, T. 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(2005). The impact of electronic health records on time efficiency of physicians and nurses: a systematics review. Journal of the American Medical Informatics Association, 12, 505-516. Simon, S. et al. (2009). Physicians’ usage of key functions in electronic health records from 2005 to 2007: a statewide survey. Journal of the American Medical Informatics Association, 16(4), 465-470. University of Dammam (2014). Electronic Health Record (EHR) Workgroup at the University of Dammam, Saudi Arabia. Retrieved from: http://ehr2011.weebly.com/ Read More