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Publication Briefs

Electronic Health Record-based Alerting Systems Can be Source of Turnover for Clinical Practices

Primary care providers (PCPs) are moving to other specialty areas or leaving medicine altogether, which may be a significant threat to high-quality care in many U.S. regions. Although multiple factors may drive PCPs' decisions to seek alternative employment, provider satisfaction with the implementation and meaningful use of electronic health records (EHRs) may pose unique retention challenges despite the HITECH (Health Information Technology for Economic and Clinical Health) Act's strong incentives for their use. For example, the use of certain components of EHRs, such as EHR-based alerting systems (EAS), might reduce provider satisfaction – a strong precursor to turnover. This study examined how providers' perceptions of the use of EAS (known within the VA CPRS as View Alert notifications) may impact their satisfaction, intention to quit, and turnover. Investigators conducted a cross-sectional web-based survey of EAS-related practices on a nationwide sample of PCPs (n=2,590) practicing at VA healthcare facilities (n=131) between June and November 2010.


  • After adjusting for independent variables, providers' perceptions of the value of EAS predicted both provider satisfaction and facility-level turnover. For example, perceptions of the degree of monitoring and feedback received regarding EAS were significantly associated with intention to quit, with high levels of monitoring and feedback associated with increased intention to quit. In all cases, these relationships were observed without relying on either provider satisfaction or intent to quit as intermediary mechanisms.
  • Monitoring/feedback on EAS practices, training on the use of EAS, and the extent to which colleagues used/valued EAS had little impact on provider satisfaction.


  • Investigators did not have access to data regarding turnover of individual providers so could not conduct more informative, longitudinal turnover analyses such as survival analysis.


  • How EHR-based alerting systems are implemented, accepted, and used in real-world clinical settings can impact not just quality of care, but also provider satisfaction and retention.

This study was funded by the VA National Center for Patient Safety and HSR&D. Drs. Hysong and Singh and Ms. Espadas are part of HSR&D's Center for Innovations in Quality, Effectiveness and Safety located in Houston, TX.

Hysong S, Spitzmüller C, Espadas D, Sittig D, and Singh H. Electronic Alerts and Clinician Turnover: The Influence of User Acceptance. American Journal of Managed Care November 2014;20(SP 17):SP520-SP530.

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What are HSR Publication Briefs?

HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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