Epic overhaul at a Canadian hospital: Pre-Post evaluation insights from physicians and medical residents
Notice bibliographique
Résumé
The implementation of Electronic Medical Records (EMRs) in hospitals offers potential benefits but often disrupts clinician workflows, affecting care delivery and outcomes. This study evaluates physicians' and medical residents’ perspectives on the impacts of introducing a new Epic system at a Canadian academic hospital. A pre-post evaluation design was conducted using physician and resident surveys before (T0) and 4- and 9-months post-implementation (T1, T2) that assessed technology use, satisfaction with training and system use, and EMR's perceived impact on care delivery, work practices and quality. Satisfaction with training and system use declined for both groups in the first four months (more sharply for residents) but several measures improved at T2 as users readjusted to the system. There was a significant increase in physicians’ daily computer use (4 h at T0 to 6 h at T1; P < . 001 ). Limited early benefits of the Epic system were observed and a decline in perceived improvement in clinical documentation (P = . 006 and .0012) , order entry (P = . 018 and .002) and patient safety (P = . 044 and .024) were reported at T1 for physicians and residents, respectively. Although some medical practice/work indicators improved by 9 months for physicians, the changes were not statistically significant; these benefits were not observed for residents at T2. Medical training was not significantly affected by the new Epic system either immediately or later post implementation. At T1, 83% of physicians reported that the new system sometimes or often improved the quality of care, as opposed to only 33% of residents; no significant improvements were noted at 9 months post implementation by both groups. Physicians and residents adapt differently to Epic and full system assimilation does not happen in one year. Early perceptions of Epic do not reflect its long-term potential, and meaningful benefits require prolonged stabilization periods for user satisfaction and efficiency gains. We caution hospital leaders not to rely heavily on a vendor-driven implementation, and recommend tailored training, rapid-cycle improvements, transparent communication, and monitoring of agreed-upon performance indicators to strengthen clinician engagement and support long-term success. • Epic implementation improved aspects of clinician workflows, but no quality-of-care impacts were reported up to 9 months. • Training satisfaction and system usability declined early with partial recovery by 9 months, underscoring adaptation challenges until stabilization. • Physicians reported the new system supported their work procedures as early as 4 months post-Epic implementation. • Epic mainly affected clinical documentation, orders entry, patient safety and flow. • Clinicians' adaptation varied, stressing the need for tailored training, rapid-cylce adjustments, and clear performance metrics.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,006 | 0,014 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,003 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».