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

OBJECTIVES: This study aimed to systematically assess the changes physicians identify as needed in their EMRs to better support safe clinical practice. METHODS: 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. RESULTS: 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]. CONCLUSIONS: 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.