HealthJune 03, 2016

Impact of EHRs on nursing practice

Electronic health records (EHR) are the key component of healthcare information systems. By now, thanks to the Health Information Technology for Economic and Clinical Health Act (HITECH) and Meaningful Use requirements, most hospitals have adopted EHRs to replace paper-based records for documentation, and most nurses are familiar with using them.

The transition period from paper records to EHRs could be problematic if users remain obstinate about changing their daily routines. According to an article in the April 2016 issue of CIN: Computers Informatics Nursing, during implementation of EHR information systems, healthcare staff might find themselves faced with difficulties because of heavy workloads and lack of time to learn how to use the new system.

A closer look

A smooth implementation streamlines clinical nursing activities. To take a look at the adoption process, a descriptive qualitative study and group interviews were conducted three months after and two years after EHR system implementation in one hospital in southern Taiwan.

The purpose of the study was to examine the perspective of nurses transitioning from paper to EHR, and to explore the adoption process of an EHR system in different implementation stages: the initial implementation stage and post-implementation stage. The findings will hopefully help improve the design and implementation of future systems across the globe.

Three main themes emerged in the first stage:

1. Nurses felt more stress in anticipation of the EHR and the liability associated with it. As EHR evolves, health record content must not focus solely on patient care, but also comply with standards to enhance the protection of healthcare workers. The study participants felt that the more detail records provided, the greater security they had either during the hospital accreditation process or when patient-nurse liability issues arose.

2. Some nurses surveyed felt the EHR system was not designed to be user-friendly. In addition, when the system failed to keep pace with the work speed, nurses had to adjust their workflow. In these situations, traditional paper-based health records were considered more flexible than EHRs.

3. Nurses also felt there was insufficient IT support and manpower backup. When technical problems occurred, the research participants expected IT personnel to assist and rapidly resolve problems. They conveyed that the IT support staff was generally friendly, but often were not able to resolve the problem in a timely manner. The delay of clinical work due to computer problems created stress for the nursing staff.

In the post-implementation stage, the following trends emerged:

4. After using the revised EHR system for a while, nurses learned how to report usage problems and obtain responses, resulting in system compliance with their specific documentation needs on patient care. When nurses were getting used to the EHR system, they hoped that the system could link with other hospital information systems or databases for data transmission or retrieval to speed up the documentation process.

5. Once nurses mastered data entry, they learned the benefits of EHR in time saving and documentation. They realized that the time saved by using EHRs could help them to get off work on time. They also found the electronic notes to be easier to read and understand than hand-written ones.

6. Some nurses expressed concerns about unrealistic expectations and goals for the future.  Because the EHR had been implemented for a while, nurses were expected to learn from the technology and report the problem correctly when interacting with IT staff.  It was their hope that the next time a new system is being considered, more staff members will be able to assist with the chaotic process.

Transitioning to an EHR requires careful consideration from numerous departments throughout the hospital. Examining the experiences of these nurses might help you avoid problems of your own in the present or future.

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