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Dissemination of extensive integrative review and evidence leveling regarding perceived EHR benefit, usability, acceptance, and satisfaction among nurses and factors associated with acceptance and satisfaction of EHR adoption/utilization from a qualitative anecdotal/focus nursing group -- RN (n=28) and NP (n=10) groups.
The EHR should be both disciplinary specific “unique and interdependent aspects … visible and understandable” (Keenan & Yakel, 2005, p. 385). Nursing leadership determined nurse satisfaction an essential indicator of patient care quality (Kossman & Scheidenhelm, 2008).
Methods:
This integrative review leveled evidence of RN-EHR-MU with perception of benefit; usability, acceptance, satisfaction and consequence as substantiated by use of adapted Melnyk/Fine-Overholt Hierarchy and Whittemore/Knafl integrative methodology. A deficiency of nursing evidence exists on this subject. The review methodology documented consistent literature perception themes inclusive of: Satisfaction, ease of use, usability, efficiency, acceptance, and either benefits or barriers (human or other) to implementation and adoption for nursing. The aforementioned terms became the analysis themes for inclusion in the review with additional criteria of nursing related not to clinician or physician research or observation. Evidence leveling and integrative review methodology resulted in selection of nineteen nurse meaningful use articles for inclusion in the EHR and RN evidence summary table corroborated a deficiency of nursing literature.
To assess ‘lessons learned’ about EHR usability, adoption and RN meaningful use; a focus group was organized through email announcements and voluntary consent in order to understand the challenges and benefits of implementing and using a new electronic health record system. Quarterly evaluation assessed nurses’ perception of usefulness, ease of use, and acceptance based upon Davis’ (1989) perception tool and the Technology Acceptance Model (TAM) appraising how RN users decide how or when they will use the new EHR technology. RN usability assessed: (1) Has the EHR met the goals and expectations originally set forth? (2) Has the EHR met the goals and expectations originally set forth in relation to (a) quality of care, (b) patient safety (c) unexpected outcomes or (d) other issues? (3) What have been the key challenges to success? and (4) What have been the key benefits to success?
Results:
Meaningful benefit, satisfaction, usability, and acceptance themes emerged along trends for enhanced perception of benefit and satisfaction
- Integrative review substantiates nursing literature scarcity regarding perception and ascertains magnitude of human/environmental/technology factors upon perception and usability.
- EHR satisfaction necessitates RNs understand how taxonomy, technology principles, discipline specific templates and Systems Life Cycle participation influence acceptance.
- Identified usability themes, human or other factors along with recognition of barriers or facilitators for adoption and utilization, ensure intuitive and meaningful HIT use.
- Familiarity with any EHR system over time improved system usability and adoption. Design of healthcare system technology lacks RN meaningful use templates and screens specific for nursing domain.
Unless nursing utilization constructs are inclusive of beneficial nursing template design with worksheets or flowsheets perceived useful, possibility of RN dissatisfaction and individualized workarounds develop
Conclusion:
Results of a qualitative antecdotal/focus nursing study corroborates limited nursing and EHR literature findings and adds to the body of knowledge regarding meaningful benefit, satisfaction, usability, and acceptance themes and trends for enhanced awareness of benefit and satisfaction measured by Perceived Usefulness, Ease of Use, and User Acceptance of Information Technology (Davis, 1989).
External variables (human or other factors) influence perceived usefulness or ease of use both of which determine RN attitude; usefulness similarly effects behavioral intention to use the HIT or EHR system. Overtime, the human or other factors previously described as essentials of nurse MU; along with belief that the particular system will enhance nursing performance modifies actual system use and eventual HIT or EHR acceptance (Bagozzi, Davis, & Warshaw, 1992). Summarized focus group themes and comments appear in the following table. Findings are consistent with other evidence leveled and evaluated using the adapted Melnyk/Fine-Overholt Hierarchy and Whittemore/Knafl integrative methodology.
RNs function in a non-linear manner for patients who are unstable physiologically or emotionally with a myriad of potential issues that might change in a matter of seconds or minutes; documentation design does not allow for adequate charting or retrieval for RN meaningful use and/or satisfaction. Rippen, Pan, Russell, Bryne, & Swift (2013) reviewed existing EHR technology literature revealing organizations “do not yet know how best to design, implement, and use [health information technology, a framework dedicated to] technology, use, environment, outcomes, and temporality [time]” is essential for implementation and expected outcome(s) (p. e1). About 80% of RNs determined electronic charting would enhance patient care; however, it was not established how this EHR documentation would influence or modify RN delivery of care (Kelley et al., 2011).
Prospective studies must use the Technology Acceptance Model-2 (TAM-2); the Task-Technology Fit (TTF) Model; the Health Information Technology Reference-Based Evaluation Framework (HITREF) or other nursing theory/framework to substantiate and level EHR and RN meaningful use evidence. Future research regarding RN experiences with EHR utilization should include additional randomized clinical trials with qualitative nursing studies, particularly in regards to advanced practice nurse roles and nursing domain template and/or taxonomy development, assessment, and/or adoption.