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Learning Objective 1: Compare nurses’ perceptions pre/post implementation of a comprehensive electronic health record (EHR).
Learning Objective 2: State 3 strategies for a successful EHR implementation.
Background In 2008, <2% of acute care hospitals had comprehensive EHRs. Little is known about nurses’ perceptions of the EHR or how perceptions change over time.
Methods. A Time series survey design, using a modified Stronge and Brodt’s (1985) Nurses’ Attitudes Towards Computerization Questionnaire.
Results 499 nurses completed baseline survey; 546 6 month; 393 18 month. Maximum survey score 100. Higher scores indicate more positive attitudes. Pre-survey mean 74.24; 6 month 66.16 (p =0.0000); 18 month 67.78. Clinically significant shifts in nurse perceptions (% agreed or strongly agreed) include EHRs:
- Allow more time for professional tasks (pre 42% 6 month 16% 18 month 20%)
- Cause a decrease in communication between departments (6%/22%/20%)
- Offer opportunity to improve patient care (71%/ 48%/58%)
- Increase efficiency (58%/32%/38%)
After 18 months, 42% of nurses felt their documentation had not improved; the most cited reasons: Too many places to document, time consuming to log in, computer availability and EHR not conducive to nursing documentation.
Subjects identified that training should be: timely, on site, as needed, during non patient care time and includes simulated patient encounters. Top recommended implementation strategies: Additional staff; 24/7 Support; nurse involvement throughout process.
Conclusion Prior to EHR implementation nurses were uncertain yet hopeful about the benefits but after 18 months their optimism was not realized. Lewin’s Theory of Change implies a state of unfreezing and freezing as a final product is reached. The adoption of an EHR does not lend itself to a steady state but rather a fluidity of constant change. Strategies that assist with reframing a major perpetual change such as the implementation of an EHR may facilitate acceptance.