Usability and impact of Electronic Health Records for Primary Care Units in Portugal

As of June 2011, the adoption of electronic prescription (EP) systems will be mandatory in Portugal. New Primary Care Units (PCU) since 2008, and increasingly, existing ones, are using a full Electronic Health Record (EHR), which is regarded as a fundamental step to improve quality of patient care. Lack of evidence persists as to professionals and patients perception of these desired outcomes of informatization efforts. Furthermore, PCUs without any or full EHR are faced with having to choose between options on the market from three EHR systems prepared and certified for General Practice: SAM Sistema de Apoio ao Medico, VitaCare and MedicineOne. We aim to explore user satisfaction and perception of quality with EHR systems for primary care available in Portugal, and their impact in medical general practice. To achieve this, we applied two cross-sectional surveys: one applied to Practitioners (S1) and another to Patients (S2). SI was designed to measure baseline demographic characteristics, attitude towards computer usage, user satisfaction with EHRs functionality, ease of use, application design, service support and perception of its impact in medical practice, namely on: a) doctor-patient relationship, b) reporting and, c) chronic disease management. S2 was designed to measure baseline demographic characteristics and patient´s perception of EHRs impact in the care being offer to them. According to practitioners, the preliminary results show that SAM is a less than adequate EHR system, obtaining a total mean score of 2,88 in a 1 to 5 scale. The main reasons are the lack of system support, a less than adequate system reliability and a poor graphical design. Both practitioners and patients feel that SAM improved PCU paper independence while general healthcare provided, such as diagnosis, chronic disease management and therapeutic choices did not change. Patient-doctor relationship degraded in the opinion of practitioners, a vision only partly shared by patients, sinc- - e most of them think it didn´t change much and regard the worsening of consulting time efficiency as the main negative effect of IT implementation in PCUs.