The study captured the moderate level of efficiency of EHR users, while according to the research results certain demographic and work factors are positively related to the perceived efficiency of EHR users. The factors "Age", "Years of exercise of the position", "Familiarity with the use of PC and ICT", "Familiarity with the use of EHR", "Education/training in relation to the use of EHR" and "Support during use of the EHR" are related, statistically significantly, to the score of the scale "Efficiency in Practicing the Tasks of the Clinical Project while Using the EHR".
The average score of the scale "Efficiency in Practicing the Tasks of the Clinical Project when Using the EHR" is 57.4/100, a value that indicates a moderate degree of efficiency of the EHR in the practice of the clinical work. Half of the participants scored between 23.6/100 and 94.4/100. The younger the age, the more positive the user efficiency rating. The shorter the work experience, the more positive the user efficiency rating. The greater the familiarity with the use of PCs and ICT, the more positive the degree of efficiency of the users. The greater the education/training, the more positive the user efficiency rating. The greater the familiarity with the use of the EHR, the more positive the degree of efficiency of the users. The greater the familiarity with the support from the HIO, the more positive the user efficiency rating.
In a sample of clinicians doctors in the USA detected negative perceptions in relation to the quality of patient care, since the use of EHR requires the expenditure of clinical time and makes interdisciplinary communication difficult and leads to the low efficiency of their work (13). Also in the USA quantitative questionnaire survey that included obstetricians/gynecologists recorded moderate overall perceived efficiency of obstetricians/gynecologists in terms of quality of care provided and communication with the patient (14).
In a cross-sectional study by Bani-Issa et al. (15) the lack of ICT skills were negatively related to their work efficiency confirming related research (16–19). In the same type of research as the one mentioned above that included as a sample pediatricians from a university hospital in Saudi Arabia, their perceived moderate efficiency in relation to the EHR was recorded. Previous training on EHR issues did not have a positive effect on users' opinions and attitudes. At the same time, the existence of technical support was significantly correlated with the research data (20). Similar results are obtained in a survey that included medical specialists in Greece. Greek doctors appeared positive in terms of their perceived efficiency, considering that the quality of care will improve, while they considered that their communication with patients is not negatively affected due to the use of the EHR (21).
In the mixed study of Joukes et al. (22) with a sample of hospital doctors of university hospitals in the Netherlands, the low perceived efficiency of users after the implementation of EHR was found. The age and previous clinical experience of the users contributes negatively to this fact, as confirmed in relevant research (23–26).
The correlation of the previous experience of the doctors in the use of the EHR, is linked to the formulation of positive opinions and attitudes towards it and to high levels of their perceived efficiency and is confirmed by a later American research (27). Likewise, in a related study involving primary care clinicians participants expressed positive perceptions regarding the quality of care and the improvement of doctor-patient communication (28). A characteristic finding is the correlation of the experience in relation to the EHR with positive opinions of the users regarding it, which documents increased use and efficiency in their work.
Also in the comparative study by Khairat et al. (29) in a similar sample of family doctors and pediatricians, the correlation between training of doctors as EHR users and their efficiency in their clinical work is established. At the same time, the need to train EHR users using appropriate educational methods adapted to the needs of doctors is highlighted. The results agree with those of Abed and Kharroubi (30) questionnaire survey of Lebanese doctors and in related surveys in minority doctors (31, 32).
The findings of the study by Bajwa et al. (16) on hospital clinicians in India confirm that computer literacy appears to have a positive effect on the efficiency of EHR users. Similar findings are also reported in a sample of primary care doctors in Malaysia, where the expected improvement in the efficiency of doctors as PC users related to previous knowledge in relation to it is confirmed (33). Similarly, Norwegian mental health practitioners who participated in a mixed survey perceive that through EHR they become more efficient (34). This fact is also confirmed in a related study that involved primary care clinicians (28).
Limitations
The limitations of the study were the lack of a sample of other health professionals such as nurses, the covid-19 pandemic and the correlation of the results only with those of the international literature, due to the absence of Cypriot scientific data.