Doc EHR use differs based on uncertainty of management perceptions

Physician perceptions of uncertainty--and the role of information technology in managing that uncertainty--heavily factor into their use electronic health record systems, according to research published online this week in the Journal of the American Medical Informatics Association.

For the study, researchers from the University of Texas Health Science Center at San Antonio, the University of Texas at Austin and the Group Health Research Institute in Seattle interviewed 28 physicians working at the same ambulatory care organization about their perceptions of uncertainty and their EHR use patterns. Specialties represented included primary care, endocrinology, gastroenterology, rheumatology, neurology and podiatry.

Based on answers received, the researchers divided the physicians into three groups:

  • Uncertainty reductionists: Physicians who used EHR information primarily to reduce uncertainty about patients, and gave priority to codified patient information above all else
  • Uncertainty absorbers: Physicians who used EHR information as a catalyst for engineering additional dialogue with others involved in the care process, and gave priority to co-created information or data that was "nearly missed during patient-physician encounters
  • Uncertainty hybrids: Physicians who placed a high priority on both codified EHR data and the accompanying care process involving colleagues.

"The findings from this study have implications for the future of health IT design, implementation and training efforts," the researchers said. "Reducible uncertainty is generally well managed with existing health IT tools. Irreducible uncertainty, however, presents a different set of challenges for health IT designers, executives and end-users."

To that end, according to the researchers, IT tools must be designed to manage such irreducible uncertainty via absorption.

"[H]ealth IT should be designed to capture physicians' thought processes and transfer these thoughts to other providers," the researchers said. "EHRs should be designed to increase the richness of the relationships and interactions among providers and between providers and their patients, and they should help both providers and patients recognize when a seemingly routine medical issue becomes non-routine."

According to researchers from Northwestern University, Geisinger Health System and Mount Sinai School of Medicine, as big data use continues to increase in healthcare, electronic health records will need to evolve simultaneously. In a viewpoint published in late March in the Journal of the American Medical Association, researchers said that EHRs are not built to handle the capacity of data created by current electronic medical tools, a problem they said will only continue to grow as data access becomes easier.

To learn more:
- here's the JAMIA study

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