Users Satisfaction with Electronic Health Records: Experience of the

Rheumatology Department at CHU Ibn Rochd of Casablanca

Zakaria El Ouali

1 a

, Samy Housbane

2 b

, Khadija Azzabi

, Kawtar Nassar

1 c

and Saadia Janani

1 d

Department of Rheumatology, CHU Ibn Rochd, Casablanca, Morocco

Medical Informatics Laboratory, Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco

Keywords: Electronic Health Records, Users Satisfaction.

Abstract: The medical record plays a key role for patients care and monitoring. It is considered as an indicator of the

quality of care. The adoption of electronic health records requires a real strategy of implementation and needs

constant monitoring to improve its function. The aim of this study was to evaluate the users’ satisfaction of

electronic health records in the Rheumatology Department at the CHU Ibn Rochd of Casablanca. A

descriptive cross-sectional study was carried out among all health professionals of the department to evaluate

the satisfaction of the users in March 2022, after 18 months of using the electronic health records. The staff

had an overall satisfaction of 96%, 84% felt that it improved the traceability of data, 88% found that it allowed

easy access to patient data and 80% admitted that it improved the feeling of professionalism and was a

teaching tool. Despite some constraints expressed by the department's staff, the overall high satisfaction and

contributions of the electronic health records indicate that this experience holds promise for widespread

implementation throughout the entire university hospital via the Hospital Information System.

1 INTRODUCTION

The Electronic Health Record (EHR) is a key element

in the quality of care. It allows easy acess to the

patient's medical history, performed examinations,

and prescribed treatments, thus promoting the

continuity of care (Bourdillon, 2006). It is a central

element in the care process and its evolution,

reflecting the broader evolution of medical practice

(Bourdillon, 2006).

The Rheumatology Department of the Ibn Rochd

University Hospital has been engaged in the

experience of implementing the EHR within its care

units since July 2020.

This work aims to study the satisfaction of EHR

users in their daily practice.

https://orcid.org/0000-0002-4997-6464

https://orcid.org/0000-0002-3973-9123

https://orcid.org/0000-0002-1879-2363

https://orcid.org/0009-0002-6226-8312

2 MATERIALS AND METHODS

2.1 Study Type

A descriptive cross-sectional study was conducted

among all healthcare staff in the Rheumatology

Department of Ibn Rochd University Hospital in

March 2022.

2.2 Inclusion and Exclusion Criteria

2.2.1 Inclusion Criteria

All the staff working in the Rheumatology

Department of CHU Ibn Rochd who have used the

EHR in 2021.

2.2.2 Exclusion Criteria

No exclusion criteria have been identified/selected.

El Ouali, Z., Housbane, S., Azzabi, K., Nassar, K. and Janani, S.

Users Satisfaction with Electronic Health Records: Experience of the Rheumatology Department at CHU Ibn Rochd of Casablanca.

DOI: 10.5220/0012769500003854

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 1st International e-Health Forum (IeHF 2023), pages 21-24

ISBN: 978-989-758-711-5

2.3 Data Collection

Data collection was conducted using a self-

administered anonymous questionnaire, completed

through two methods:

• An electronic questionnaire via Google

Forms sent to all resident doctors and interns

in the department.

• A paper questionnaire for the department's

secretaries.

The questionnaire (see Appendix) was developed

based on two user satisfaction questionnaires

regarding EHR found in the literature (Liu et al.,

2013), translated into French using 'Deepl'. It consists

of four parts:

• Sociodemographic criteria

• Questions regarding professional practice

and computer use

• Evaluation of EHR satisfaction using a five-

level Likert scale (strongly disagree,

disagree, neither agree nor disagree, agree,

strongly agree) concerning overall

satisfaction, EHR use, use of structured

forms, technical and time-related aspects,

impact on the doctor-patient relationship,

and patient safety

• Feedback and secondary use

The questionnaire also includes an open-ended

question to gather comments from users about their

experience with the EHR.

2.4 Data Analysis

A descriptive analysis of the data was conducted.

Quantitative variables (age, years of practice) were

represented by mean and standard deviation, as well

as minimum and maximum values. Qualitative

variables were presented by the count and percentage

of their categories.

The percentage of agreement was calculated as

the sum of the percentage of users responding with

agree and strongly agree.

3 RESULTS

3.1 User Characteristics

Twenty-six users responded to our EHR user

satisfaction survey (60% of the personnel in the

Rheumatology Department, constituting 100% of

EHR users).

3.1.1 Age of Participants

The average age of the users was 30.5 years with a

standard deviation of 5 years. The minimum age was

26 years and the maximum was 49 years.

3.1.2 Sex of Participants

Ninety-two percent of the participants were females,

while 8% were males.

3.1.3 Profile of Participants

There were 22 physicians (85%) and 4 (15%)

secretaries who participated in the study.

3.1.4 Seniority of Participants

The average seniority of the EHR users who

responded to our satisfaction survey was 3 years with

a standard deviation of 2.5 years. The minimum

seniority was 9 months, and the maximum was 9

years.

3.1.5 Computer Usage Level

Out of the EHR users, 14 individuals (54%) had an

average level of computer usage, 9 (34.6%) had a

basic level, and 3 (11.5%) had a high level of

computer usage.

3.1.6 Duration of EHR Usage

Two individuals (8%) have been using HER for less

than 3 months, 1 individual (4%) between 3 and 6

months, 5 individuals (18%) between 6 months and 1

year, while 18 individuals (69%) have been using

EHR for more than one year.

3.2 User Satisfaction

The results of user satisfaction survey are presented

in Table 1.

Twenty-five users (96%) are generally satisfied,

among which 8 (32%) are highly satisfied. Twenty-

one users (84%) believe that the computerized patient

file allows for better traceability. Nineteen users

(86%) confirm that semi-structured forms are suitable

for the specialty. However, 25% still prefer writing

on paper, and 46% prefer free text. This preference is

explained by the physicians' need to compose

paragraphs in certain sections.

IeHF 2023 - International e-Health Forum

Table 1: User satisfaction with the EHR in the Rheumatology Department of the Ibn Rochd University Hospital in Casablanca.

Item

Question

Number of Agreements

Percentage of Agreement

Satisfaction

Generally satisfied

Favorable opinion of colleagues

Prefers writing on paper

Benefits

Improves healthcare provision

Allows better traceability

Reduces medical errors

Enables tracking of laboratory results

Enables good communication / coordination

Rapidly accessible patient history

Sense of professionalism

Represents a teaching tool

Structure

Forms adapted to the specialty

Prefers free text

Technical and

Practical

Aspects

Consumes more time than paper forms

Increases workload

Available technical support

Frequent breakdowns

Patient Safety

Compromises patient safety

Sixteen users (64%) find that the EHR enables

good communication and coordination among

healthcare professionals within the department, as

there is no sharing with other departments or at the

hospital level.

3.3 Feedback Meeting Assistance

Eight individuals (32%) assisted once to a feedback

meeting, while 1 individual (4%) assisted twice or

more. Sixteen individuals (64%) never assisted to a

feedback meeting.

3.4 Feedback from Hierarchical

Superiors

Fifteen (60%) of the users received feedback from

hierarchical superiors or colleagues after feedback

meetings.

3.5 Participation in Scientific Works

Twenty-four percent of the users participated in

scientific works issued from EHR, while 76% did not

participate in such works.

3.6 User Comments

Here are the user comments:

• Generalize the experience to all departments.

• Automatically record summaries/reports.

• Free up Wi-Fi for the use of other work-related

applications.

• Schedule multiple appointments for the same

patient on the same day.

• Increase the internet connection speed.

• Manage system failures.

• Educate patients about the system: explaining

that looking at the screen is simply the doctor

reviewing their medical record. Many patients

quickly feel that the doctor is paying more

attention to the screen.

• Avoid requiring identification for each session

closure (after a certain period of time).

4 DISCUSSION

This study confirms statements regarding the

satisfaction of the Rheumatology Department staff

with the EHR and its contributions to continuity of

care. Indeed, after 18 months of EHR use, the

Rheumatology Department staff reports an overall

satisfaction rate of 96% and believes that the EHR has

contributed to better data traceability (84% of users),

easy access to patient data (88% of users), and

improved professionalism (80% of users). These

findings are consistent with the literature: Alex G and

Paul Cohen reported in 2006 on the Valaisan EHR

user satisfaction evaluation that 70% of users

positively assessed the EHR effect on patient

information accessibility and improvement in

communication among healthcare professionals

Users Satisfaction with Electronic Health Records: Experience of the Rheumatology Department at CHU Ibn Rochd of Casablanca

(Gnaegi et al., 2006). These results are also consistent

with other studies in the literature (Liu et al., 2013)

Regarding medical data structuring, the staff

appreciates the use of semi-structured reports, finding

them suitable for the Rheumatology specialty (86%

of users) and considering them as a teaching tool

(80% of users).

However, there are several challenges and

discomforts related to EHR use. Our survey showed

that 25% of the individuals prefer writing on paper,

48% feel that the EHR increases workload and

consumes more time compared to paper patient

records, 46% prefer free-text format for clinical

descriptions in their reports, 28% report frequent

network-related issues accessing the EHR, 20%

believe that EHR compromises patient safety.

Among the major challenges in EHR adoption is

data quality and the percentage of missing data,

making its exploitation difficult and sometimes

inefficient (Ta & Weng, 2019). The Rheumatology

Department staff is aware of the importance of data

quality in terms of traceability and completeness, as

well as the significance of data structuring. A policy

focusing on supervising data completeness and

quality, as well as adopting coding data standards,

will be implemented after fostering a culture of

digitizing care practices.

These challenges and discomforts in EHR user

satisfaction are commonly reported in literature.

Various explaining factors include user's personal

characteristics, organizational aspects of the system

(user involvement in the project, sustainable

communication), and the quality and continuous

presence of technical support (Frisina et al., 2022;

Janett & Yeracaris, 2020; Kalankesh et al., 2020;

Williams et al., 2019).

Regarding future perspectives for the

Rheumatology EHR, the transition to an interoperable

Hospital Information System (HIS) represents the

next step of medical records computerization process.

The Rheumatology Department staff, following their

local EHR experience, is looking forward to

extending the EHR to the entire university hospital,

and to integrating it into the new HIS recently adopted

by Ibn Rochd University Hospital in 2021. Sharing

data across different clinical services and existing

information systems aims at providing better

multidisciplinary patient care within the university

hospital and its affiliated hospitals.

Moreover, the EHR allows easy storage and

access to thousands of patient records, facilitating

case studies spanning several years. Secondary use of

this data is a secondary goal for the Rheumatology

Department professors and residents, allowing them

to assess their practice and contribute to scientific

research.

5 CONCLUSIONS

The local experience of EHR in the Rheumatology

Department at CHU Ibn Rochd of Casablanca shows

the great benefits for health professionals as well as

for the patients quality of care and follow-up. Despite

the constraints and discomfort expressed by the

department's staff, the overall high satisfaction and

contributions of the EHR in providing easy access to

patient data, along with its increasing adoption over

time, indicate that this experience holds promise for

widespread implementation throughout the entire

university hospital via the Hospital Information

System.

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IeHF 2023 - International e-Health Forum