731 - Electronic Health Record Usability and Clinician Satisfaction when caring for Children with Medical Complexity

The number of Children with Medical Complexity (CMC) is increasing due to improved survival rates and our ability to manage severe, chronic illness (Cohen 2011). While CMC have varying disease processes, they share increased resource utilization secondary to needs for medical technology, polypharmacy, extensive care coordination, and frequent and prolonged hospitalizations. 

There is a paucity of data on clinician satisfaction with the electronic health record (EHR) when caring for CMC. Well-designed EHR tools have been shown to reduce cognitive load, improve task prioritization, reduce documentation time, and improve user satisfaction (Pollack 2020, Semanik 2021). EHR improvements may help alleviate the challenges associated with the inpatient care of CMC.

Objective:

To evaluate usability of and clinician satisfaction with the EHR in the context of caring for CMC at a large academic pediatric hospital and to identify key areas for targeted interventions.

Design/Methods:

Cross-sectional study of pediatric faculty and advanced practice providers across specialties using an online REDCap survey. EHR usability was measured with six validated questions from the National Usability-Focused Health Information System Scale (NuHISS), and satisfaction with common EHR functionalities was measured with six original Likert-scale questions and three free-text questions. Results were analyzed with bivariate testing.

Results:

Overall, respondents (n=80, response rate 56%) who agreed or were neutral were in the majority when asked the six positively-phrased validated usability questions. Respondents were most dissatisfied with the information quality of the summary view and most satisfied with physician communication (Figure 1). Older respondents were less satisfied with EHR usability (p< 0.01) and emergency medicine was the least satisfied division (p=0.01). 

Focusing on functionalities needed for CMC, the majority of respondents were dissatisfied with chart review. Fewer respondents were satisfied with order entry (p=0.002) and documentation (p=0.017) when caring for CMC compared to caring for other patients (Figure 2). The most cited challenges were locating recent patient data, performing an accurate medication reconciliation, and lack of specialized documentation templates.

Conclusion(s):

Clinicians are less satisfied with common EHR functionalities when caring for Children with Medical Complexity compared to caring for all other patients. Targeted interventions to improve usability and common EHR functionalities for CMC are necessary to improve the user experience.