Closing the Gap: Physician Perspectives on EMR Changes Needed to Support Safe Clinical Care

This study aimed to systematically assess the changes physicians identify as needed in their EMRs to better support safe clinical practice.

Data were obtained from a national survey on EMR usability and patient safety conducted among Swiss physicians in 2024. Responses to the open-ended question "What should change in 'MySystem' to better support you in working safely?" were categorized inductively. When a respondent mentioned more than 1 change, these were split into separate statements. Inter-rater reliability was assessed in 2 rounds (subcategory κ=0.63, major category κ=0.70). Differences between physician subgroups were examined using a design-based F-adjusted test to account for clustering.

A total of 1479 statements from 809 physicians were categorized into 9 major categories and 24 subcategories. Improvements in usability were the most frequently expressed need (33.4%), followed by better workflow integration (12.4%) and integration of emerging features and technologies (12.2%). Significant differences were observed in the comments between hospital and medical practice physicians [F(7.82, 6321.44)=5.92, P<0.001], between residents and higher hierarchy physicians [F(7.83, 4760.09)=5.05, P<0.001], and between 4 major hospital EMR systems [F(21.58, 9410.64)=6.34, P<0.001].

This study provides a systematic assessment of physicians' self-expressed EMR change needs in relation to patient safety. These needs differed substantially across EMR systems, work settings, and medical roles. Our findings indicate that changes are needed at 2 levels: direct modifications to EMR systems and changes to implementation and training practices. Systematically incorporating frontline clinician perspectives into EMR design, development, and implementation is essential to advancing patient safety.