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We assessed patient experiences before and one year after electronic health record (EHR) implementation among primary care practices in New York City. These practices represented an ethnically diverse population in lower-income, urban communities. Surveys, available in English, Spanish, and Chinese languages, were administered at 10 sites. Generally, patients reported positive responses during both periods. After EHR implementation, patients were more likely to want e-mail communication with their doctors' office. The 70% of patients with Internet access were generally more satisfied with their experience and more likely to recognize benefits of EHRs. However, older patients and those with lower education levels or chronic diseases were significantly less likely than their counterparts to use the Internet. Therefore, disparities in Internet access could potentially lead to unequal access and use of healthcare if not addressed. Practices should routinely record patient communication preferences within the EHR, to tailor communications and improve patient experiences.
KEY WORDS: Patient experiences; electronic health record; CAHPS; Internet access; medically underserved area; ambulatory care; meaningful use.
The American Recovery and Reinvestment Act (ARRA) of 2009 is making widespread electronic health record (EHR) implementation a reality. By demonstrating "Meaningful Use" of EHRs, Medicare and Medicaid providers are now eligible for federal funding to compensate for the support system, hardware, and software needed to transition from paper records.1
Patient experience has been shown to affect healthcare quality by influencing patient satisfaction, adherence to treatment, clinical outcomes, and practices' business performance.2Yet in a 2009 systematic review3 evaluating patient satisfaction before and after EHR implementation, few relevant studies were identified, and those studies included small numbers of patients at single large academic1 or umbrella organizations (e.g., Veterans Affairs,5 Kaiser Perniante,6 Mayo Clinic,7 and Geisinger8). Patient experience at these offices was generally positive or neutral, but these results may not be generalizable to widespread EHR implementation, especially in small medical practices.
In 2005, the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) initiated the Primary Care Information Project (PCIP) to implement EHRs in independent small primary care offices and community health center (CHC) sites in low-income urban neighborhoods. The city granted eligible practices (primary care providers with more than 10% Medicaid and uninsured patients) a package of subsidized software and services. By October 2008, PCIP had...