Emergency Physician Experiences with Electronic Health Records in the United States and Norway: Qualitative Study (Preprint)

BACKGROUND Physician attitudes regarding Electronic Health Records (EHR) are widely recognized. It has also been established that both human and technologic components contribute to user satisfaction. This study compares emergency physician EHR experiences between the United States and Norway. OBJECTIVE The primary outcome analyzes individual perceptions of Health Information Technology (HIT). It examines independent variables that influence overall user experience within a socio-political-technical context. Fundamental differences between nations will also be addressed. METHODS This exploratory study used semi-structured, respondent-driven, in-depth interviews (n=12) that were recorded and transcribed. Thematic analysis was conducted using grounded theory and ethnography. RESULTS Potential benefits and disadvantages were acknowledged by all physicians. Both cohorts reported increased clerical burden. Overall, Norwegians were more likely to report positive EHR experiences while American dissatisfaction was disproportionally high. US frustrations were multifactorial all resulting with similar consequences- generation of excessive data with little clinical value. They also felt EHRs prioritized capital gain over healthcare optimization. Norwegian complaints mainly involved technology dysfunction. The initiative “One Patient, One Record” (Én innbygger - én journal) will soon result in a single EHR provider (Epic Systems) for the entire nation. Currently, all EHRs in Norway are connected to a national health information exchange (HIE) platform known as the “core journal” (Kjernejouralen) which contains prescription and critical medical information to providers across the country. US physicians expressed interest in having a version of this tool as they often cannot obtain outside patient records. CONCLUSIONS Despite differences spanning geographic, organizational, and cultural boundaries much is to be learned by direct comparison of individual experiences. This study suggests policy, regulation, and culture may have greater influence on overall user experience rather than technology itself. Global EHR optimization requires additional investigation and these results help establish foundation for future research.