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Overall experience and satisfaction of genetic clinicians with electronic health records (EHR) 

Clinical Genetics and Therapeutics
  • Primary Categories:
    • Genomic Medicine
  • Secondary Categories:
    • Genomic Medicine
Introduction:
Electronic health records (EHR) adoption has increased significantly in the last decade. In 2011, 28% of non-federal acute care hospitals and 34% of office-based physicians utilized a certified EHR, increasing to 96% and 78%, respectively, by 2021. This increase was supported by the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 which provided financial incentives to encourage the use of federally certified EHR technologies. While EHRs are now commonly used, studies have shown they have challenges such as increased charting time, reduced clinical care time, and decreased job satisfaction. The objective of this study was to evaluate the EHR user experience and satisfaction of clinicians in the medical genetics and genomics field.  

 

Methods:
An anonymous survey was designed to assess the EHR experience and satisfaction of genetic clinicians. Questions were a mix of multiple-choice questions, open-ended questions, Likert, and ratings. The survey was sent to over 100 practicing genetic clinicians in the United States via genetics related listservs. Clinicians included medical geneticists, genetic counselors, genetics advance practice providers, and other clinical providers. Results were reviewed in aggregate. 

 

Results:
45 individuals initially responded: 19 physicians, 4 physician associates, 14 nurse practitioners, 6 genetic counselors, 1 registered nurse, and 1 dietician. Ages ranged from 26 to 67 years, and 91% (41/45) practiced full time. Genetics clinical experience ranged from 2 to 41 years. 78% (35/45) practiced in an academic medical center. 82% (37/45) used EPIC for outpatient and inpatient settings, and the remainder used Oracle/Cerner, Sunrise, or another EHR. 18% (8/45) were very satisfied, 44% (20/45) were satisfied, 20% (9/45) were neutral, 13% (6/45) were dissatisfied, and 4% (2/45) were very dissatisfied with their EHR. 42% (19/45) had completed non-mandatory EHR training modules. Of these individuals, 63% (12/19) found the additional training helpful, and 37% (7/19) found the training neither helpful nor unhelpful. 20% (9/45) of the clinicians had a genetic/genomic EHR module adopted by their institution, 69% (31/45) did not, and 11% (5/45) were not sure. 70% (31/44) sent genetic testing internally, and of these individuals, 74% (23/31) found it very easy or easy to find test results. For external results, only 36% (16/44) found them very easy or easy to find. For internal genetic tests, 65% (20/31) of the clinicians imported results into their documentation by selecting text and copying/pasting, 52% (16/31) by taking a screenshot and then pasting in the image, and/or 45% (14/31) by manually typing in results. For external genetic tests, 45% (20/44) of the clinicians imported results into their documentation by selecting text and copying/pasting, 61% (27/44) by taking a screenshot and then pasting in the image, and/or 57% (25/44) by manually typing in results. There was a wide range of open-ended suggestions for improvement and desired functionalities. 

Conclusion:
There is a need for EHR improvement for clinical genetics given the wide range of satisfaction levels. Despite available EHR training being reported as helpful by most individuals who had completed some, the utilization was low. Internally completed genetic testing was much easier to find than externally completed testing. Most individuals were importing both internal and external genetic test results into documentation with multi-step functions and/or manually in some way which is time consuming and increases errors. There is demand for more genetic functionalities, some which already exist but are not easily accessible as most institutions have not yet adopted genetics/genomics EHR modules. Future evaluation is needed to determine how to improve the interoperability of genetic testing with EHRs to improve efficiency and accuracy.  

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