J Am Med Inform Assoc 19:401-406 doi:10.1136/amiajnl-2011-000333
  • Research and applications
  • Focus on health information technology, electronic health records and their financial impact

Transitioning between ambulatory EHRs: a study of practitioners' perspectives

  1. Rainu Kaushal1,3,4,5
  1. 1Department of Pediatrics, Weill Cornell Medical College, New York, New York, USA
  2. 2Division of Respiratory Diseases, Children's Hospital Boston, Boston, Massachusetts, USA
  3. 3Department of Public Health, Weill Cornell Medical College, New York, New York, USA
  4. 4Komansky Center for Children's Health, New York-Presbyterian Hospital, New York, New York, USA
  5. 5Department of Medicine, Weill Cornell Medical College, New York, New York, USA
  1. Correspondence to Dr Rainu Kaushal, 402 East 67th Street, New York, NY 10065, USA; rak2007{at}
  • Received 26 April 2011
  • Accepted 31 July 2011
  • Published Online First 28 August 2011


Objective To evaluate practitioners' expectations of, and satisfaction with, older and newer electronic health records (EHRs) after a transition.

Material and methods Pre- and post-transition survey administered at six academic-affiliated ambulatory care practices from 2006 to 2008. Four practices transitioned to one commercial EHR and two practices to another. We compared respondents' expectations of, and satisfaction with, the newer EHR.

Results 523 subjects were eligible: 217 were available before transition and 306 after transition. 162 pre-transition and 197 post-transition responses were received, yielding 75% and 64% response rates, respectively. Practitioners were more satisfied with the newer EHRs (64%) compared with the older (56%) (p=0.15) and a small majority (58%) were satisfied with the transition. Practitioners' satisfaction with the older EHRs for completing clinical tasks was high. The newer EHRs exceeded practitioner expectations regarding remote access (61% vs 74%; p=0.03). However, the newer EHRs did not meet practitioners' expectations regarding their ability to perform clinical tasks, or more globally, improve medication safety (81% vs 61%; p<0.001), efficiency (70% vs 44%; p<0.001), and quality of care (77% vs 67%; p=0.04).

Discussion Most practitioners had favorable opinions about EHRs and reported overall improved satisfaction with the newer EHRs. However, practitioners' high expectations of the newer EHRs were often unmet regarding facilitation of specific clinical tasks or for improving quality, safety, and efficiency.

Conclusion To ensure practitioners' expectations, for instance regarding improvements in medication safety, are met, vendors should develop and implement refinements in their software as practices upgrade to newer, certified EHRs.


  • Funding This project was supported by the United Hospital Fund (grant number 061118S) and New York-Presbyterian Hospital.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of Weill Cornell Medical College.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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