Preliminary Results Power analysis showed a need to survey 161 subjects per group in order to find a...
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Preliminary Results Power analysis showed a need to survey 161 subjects per group in order to find a 5% change in satisfaction with α=0.05 and β=0.2. To date, 135 subjects have completed the pre-implementation survey. Survey sub-scores, stratified by diagnosis, appear below. Numbers represent average satisfaction on a 1-to-5 scale (1=least satisfied). Conclusion: When psychiatric providers wrote encounter notes by hand, average scores within any satisfaction subscale, stratified by the subjects' diagnosis, were not significantly different from each other. Six months after EHR implementation, we will Post-Implementation System-wide EHR Psychiatric EHR Study: (Nov. 2004-Dec. 2005) Six-month acclimation (Jan- June 2005) Post-Implementation Surveys (July 2005-June 2006) Effect of Electronic Charting on the Patient- Psychiatrist Relationship Randall F. Stewart M.D., Mark Schuyler, M.D., Bob Bailey, M.D., Philip J. Kroth, M.D., M.S. THE UNIVERSITY OF NEW MEXICO, ALBUQUERQUE, NM Setting Subjects are adult outpatients recruited from three ambulatory clinics at the University of New Mexico Psychiatric Center (UNMPC), a public, not-for-profit community mental health center located in Albuquerque. The Behavioral Health EHR ("CRIS") Background Many studies since the early 1980’s have shown that patients accept the use of computers in the delivery of health care 1 , but with some concerns: Communication style becomes less fluent 2 Confidentiality concerns increase 3 Anxiety increases or decreases less than without computers 4 Physicians seem less “ideal” 5 We have found no studies that specifically included psychiatric patients. Because psychiatry relies almost exclusively on communication for diagnosis and treatment evaluation, the above factors may disproportionately affect psychiatric patients. Because of this, we believe that psychiatric patients warrant specific study. As 20,000 outpatient visits per year All types of psychiatric illnesses Staff of approximately 60 physicians and 36 residents. Dec. 2005 Study Design Hypothesis: The use of an Electronic Health Record (EHR) for charting of psychiatric encounters will affect aspects of the Patient- Psychiatrist relationship. Design: Quasi-experimental, before-and-after study. Independent variable: Paper vs. electronic charting Dependent variable: Aspects of the patient- psychiatrist relationship Instrument: A self-administered, paper-based questionnaire based on the Patient Satisfaction Questionnaire-18 (PSQ-18). Covariates: Diagnoses and demographic data. Beginning approximately December 2005, behavioral health divisions at UNM will implement a computerized system (shown at right) for encounter narratives. After a six-month acclimation period to avoid transient results due to initial adjustment, subjects will take the survey again to evaluate for changes to aspects of the patient- psychiatrist relationship. References 1. Mitchell, E., Sullivan, F. A descriptive feast but an evaluative famine: systematic review of published articles on primary care computing during 1980-97. BMJ 2001; 322: 279-82. 2. Urkin, J., Warshawsky, S.S., Pliskin, J.S., Cohen, N., Sharon, A., Binstok, M., Margolis, C.Z. How does a computerized medical record (CMR) affect physicians’ work style? A video recorded study. Proceedings of the American Medical Informatics Association 1993 Spring Congress, p.89, St. Lous, Mo. 3. Brownbridge, G., Herzmark, G.A., Wall, T.D. Patient reactions to doctors’ computer use in general practice consultations. Social Science & Medicine 1985; 20(1): 47-52. 4. Cruickshank, P.J. Patient stress and the computer in the consulting room. Social Science & Medicine 1982; 16:1371-6. 5. Cruickshank, P.J. Patient rating of doctors using computers. Social Science & Medicine 1985; 21(6): 615-22. 6. U.S. Census Bureau; “Profiles of General Demographic Characteristics;” published May 2001; <http://www.census.gov/prod/cen2000/dp1/2kh35.pdf> This study is funded by National Library of Medicine Grant No. 1 F37 LM008747-01 and Pre-Implementation Satisfaction Scores Subscale→ ↓ Diagnosis Listening & Attentiveness Communication & Education Confidential ity & Stigma Competency & Trust Stress & Anxiety Computer Use General Overall Average Mood: 2.81 2.63 2.61 3.35 2.98 2.76 3.70 3.00 Anxiety: 2.70 2.79 2.70 3.39 2.27 2.74 3.77 3.00 Psychotic: 2.74 2.84 2.79 3.09 2.80 2.88 3.64 2.98 Personality: 2.82 2.80 2.80 3.09 2.53 2.73 3.67 2.96 Substance Use: 2.86 2.71 2.71 3.21 2.88 2.73 3.39 2.95 Other: 2.88 2.76 2.92 3.49 3.42 2.72 2.85 3.14 ANOVA p: 0.33 0.77 0.88 0.11 0.13 0.92 0.08 0.15 Pre-Implementation Demographic Profile Demographics Study Albuquerque 6 Caucasian: 66.9% 49.9% Hispanic: 24.3% 39.9% African-American: 3.9% 3.1% Other: 4.9% 7.1% Males: 49.6% 48.57% Females: 50.4% 51.43% Average age: 46.2 yrs 34.9 yrs Subjects’ demographics are similar to those of the population of the city of Albuquerque. Differences in race may be due to cultural factors in mental health seeking behaviors. Our sample did not include any children. Albuquerque Albuquerque Albuquerque UNM Psychiatric Center, Albuquerque, New Mexico The selected EHR (“Clinical Research Information System,” or “CRIS”) was developed specifically for Behavioral Health at Duke University. Its modular design uses structured data entry facilitated by a graphical user interface and hierarchical menu selections.
Transcript of Preliminary Results Power analysis showed a need to survey 161 subjects per group in order to find a...
Preliminary ResultsPower analysis showed a need to survey 161 subjects per group in order to find a 5% change in satisfaction with α=0.05 and β=0.2. To date, 135 subjects have completed the pre-implementation survey.
Survey sub-scores, stratified by diagnosis, appear below. Numbers represent average satisfaction on a 1-to-5 scale (1=least satisfied).
Conclusion: When psychiatric providers wrote encounter notes by hand, average scores within any satisfaction subscale, stratified by the subjects' diagnosis, were not significantly different from each other. Six months after EHR implementation, we will re-survey patients in order to investigate for changes in scores that may be affected by the interaction between charting method (paper vs. electronic) and patient diagnosis.
Preliminary ResultsPower analysis showed a need to survey 161 subjects per group in order to find a 5% change in satisfaction with α=0.05 and β=0.2. To date, 135 subjects have completed the pre-implementation survey.
Survey sub-scores, stratified by diagnosis, appear below. Numbers represent average satisfaction on a 1-to-5 scale (1=least satisfied).
Conclusion: When psychiatric providers wrote encounter notes by hand, average scores within any satisfaction subscale, stratified by the subjects' diagnosis, were not significantly different from each other. Six months after EHR implementation, we will re-survey patients in order to investigate for changes in scores that may be affected by the interaction between charting method (paper vs. electronic) and patient diagnosis.
Psychiatric Computer use: Current Post-Implementation
Lab Inquiry & Rx: System-wide EHR System-wide EHR
Encounter Narratives: Handwritten Notes Psychiatric EHR
Study:Pre-implementation surveys
(Nov. 2004-Dec. 2005)Six-month acclimation
(Jan-June 2005)Post-Implementation Surveys
(July 2005-June 2006)
.
Effect of Electronic Charting on the Patient-Psychiatrist Relationship
Randall F. Stewart M.D., Mark Schuyler, M.D., Bob Bailey, M.D., Philip J. Kroth, M.D., M.S.
THE UNIVERSITY OF NEW MEXICO, ALBUQUERQUE, NM
SettingSubjects are adult outpatients recruited from three ambulatory clinics at the University of New Mexico Psychiatric Center (UNMPC), a public, not-for-profit community mental health center located in Albuquerque.
The Behavioral Health EHR ("CRIS")
SettingSubjects are adult outpatients recruited from three ambulatory clinics at the University of New Mexico Psychiatric Center (UNMPC), a public, not-for-profit community mental health center located in Albuquerque.
The Behavioral Health EHR ("CRIS")
BackgroundMany studies since the early 1980’s have shown that patients accept the
use of computers in the delivery of health care1, but with some concerns:
Communication style becomes less fluent2
Confidentiality concerns increase3
Anxiety increases or decreases less than without computers4
Physicians seem less “ideal”5
We have found no studies that specifically included psychiatric patients. Because psychiatry relies almost exclusively on communication for diagnosis and treatment evaluation, the above factors may disproportionately affect psychiatric patients. Because of this, we believe that psychiatric patients warrant specific study. As the nation accelerates the drive towards more computerized health care, this investigation takes on additional urgency.
BackgroundMany studies since the early 1980’s have shown that patients accept the
use of computers in the delivery of health care1, but with some concerns:
Communication style becomes less fluent2
Confidentiality concerns increase3
Anxiety increases or decreases less than without computers4
Physicians seem less “ideal”5
We have found no studies that specifically included psychiatric patients. Because psychiatry relies almost exclusively on communication for diagnosis and treatment evaluation, the above factors may disproportionately affect psychiatric patients. Because of this, we believe that psychiatric patients warrant specific study. As the nation accelerates the drive towards more computerized health care, this investigation takes on additional urgency. 20,000 outpatient visits per year
All types of psychiatric illnessesStaff of approximately 60 physicians and 36 residents.
Dec. 2005
Study DesignHypothesis: The use of an Electronic Health Record (EHR) for charting of psychiatric encounters will affect aspects of the Patient-Psychiatrist relationship.Design: Quasi-experimental, before-and-after study. Independent variable: Paper vs. electronic chartingDependent variable: Aspects of the patient-psychiatrist relationshipInstrument: A self-administered, paper-based questionnaire based on the Patient Satisfaction Questionnaire-18 (PSQ-18).Covariates: Diagnoses and demographic data.
Beginning approximately December 2005, behavioral health divisions at UNM will implement a computerized system (shown at right) for encounter narratives. After a six-month acclimation period to avoid transient results due to initial adjustment, subjects will take the survey again to evaluate for changes to aspects of the patient-psychiatrist relationship.
Study DesignHypothesis: The use of an Electronic Health Record (EHR) for charting of psychiatric encounters will affect aspects of the Patient-Psychiatrist relationship.Design: Quasi-experimental, before-and-after study. Independent variable: Paper vs. electronic chartingDependent variable: Aspects of the patient-psychiatrist relationshipInstrument: A self-administered, paper-based questionnaire based on the Patient Satisfaction Questionnaire-18 (PSQ-18).Covariates: Diagnoses and demographic data.
Beginning approximately December 2005, behavioral health divisions at UNM will implement a computerized system (shown at right) for encounter narratives. After a six-month acclimation period to avoid transient results due to initial adjustment, subjects will take the survey again to evaluate for changes to aspects of the patient-psychiatrist relationship.
References1. Mitchell, E., Sullivan, F. A descriptive feast but an evaluative famine: systematic review of published articles on primary care computing during 1980-97. BMJ
2001; 322: 279-82.2. Urkin, J., Warshawsky, S.S., Pliskin, J.S., Cohen, N., Sharon, A., Binstok, M., Margolis, C.Z. How does a computerized medical record (CMR) affect
physicians’ work style? A video recorded study. Proceedings of the American Medical Informatics Association 1993 Spring Congress, p.89, St. Lous, Mo.3. Brownbridge, G., Herzmark, G.A., Wall, T.D. Patient reactions to doctors’ computer use in general practice consultations. Social Science & Medicine 1985;
20(1): 47-52.4. Cruickshank, P.J. Patient stress and the computer in the consulting room. Social Science & Medicine 1982; 16:1371-6.5. Cruickshank, P.J. Patient rating of doctors using computers. Social Science & Medicine 1985; 21(6): 615-22.6. U.S. Census Bureau; “Profiles of General Demographic Characteristics;” published May 2001; <http://www.census.gov/prod/cen2000/dp1/2kh35.pdf>
This study is funded by National Library of Medicine Grant No. 1 F37 LM008747-01 and supported by DHHS-NIH-NCRR GCRC Grant No. 5M01-RR00997.
References1. Mitchell, E., Sullivan, F. A descriptive feast but an evaluative famine: systematic review of published articles on primary care computing during 1980-97. BMJ
2001; 322: 279-82.2. Urkin, J., Warshawsky, S.S., Pliskin, J.S., Cohen, N., Sharon, A., Binstok, M., Margolis, C.Z. How does a computerized medical record (CMR) affect
physicians’ work style? A video recorded study. Proceedings of the American Medical Informatics Association 1993 Spring Congress, p.89, St. Lous, Mo.3. Brownbridge, G., Herzmark, G.A., Wall, T.D. Patient reactions to doctors’ computer use in general practice consultations. Social Science & Medicine 1985;
20(1): 47-52.4. Cruickshank, P.J. Patient stress and the computer in the consulting room. Social Science & Medicine 1982; 16:1371-6.5. Cruickshank, P.J. Patient rating of doctors using computers. Social Science & Medicine 1985; 21(6): 615-22.6. U.S. Census Bureau; “Profiles of General Demographic Characteristics;” published May 2001; <http://www.census.gov/prod/cen2000/dp1/2kh35.pdf>
This study is funded by National Library of Medicine Grant No. 1 F37 LM008747-01 and supported by DHHS-NIH-NCRR GCRC Grant No. 5M01-RR00997.
Pre-Implementation Satisfaction Scores
Subscale→
↓ DiagnosisListening &
AttentivenessCommunication
& EducationConfidentiality
& StigmaCompetency
& TrustStress & Anxiety
Computer Use General
Overall Average
Mood: 2.81 2.63 2.61 3.35 2.98 2.76 3.70 3.00
Anxiety: 2.70 2.79 2.70 3.39 2.27 2.74 3.77 3.00
Psychotic: 2.74 2.84 2.79 3.09 2.80 2.88 3.64 2.98
Personality: 2.82 2.80 2.80 3.09 2.53 2.73 3.67 2.96
Substance Use: 2.86 2.71 2.71 3.21 2.88 2.73 3.39 2.95
Other: 2.88 2.76 2.92 3.49 3.42 2.72 2.85 3.14
ANOVA p: 0.33 0.77 0.88 0.11 0.13 0.92 0.08 0.15
Pre-Implementation Demographic Profile
Demographics Study Albuquerque6
Caucasian: 66.9% 49.9%
Hispanic: 24.3% 39.9%
African-American: 3.9% 3.1%
Other: 4.9% 7.1%
Males: 49.6% 48.57%
Females: 50.4% 51.43%
Average age: 46.2 yrs 34.9 yrs
Subjects’ demographics are similar to those of the population of the city of Albuquerque. Differences in race may be due to cultural factors in mental health seeking behaviors. Our sample did not include any children.
AlbuquerqueAlbuquerqueAlbuquerque
UNM Psychiatric Center, Albuquerque, New Mexico
The selected EHR (“Clinical Research Information System,” or “CRIS”) was developed specifically for Behavioral Health at Duke University. Its modular design uses structured data entry facilitated by a graphical user interface and hierarchical menu selections.
