Nurses' use of an integrated electronic health record: results of a case site analysis

Abstract

Purpose: To explore how nurses use an integrated Electronic Health Record (EHR) in practice.

Methods: A multi-site case study across two hospitals in Kaiser Permanente Northern California. Non-participant observation was used to explore nurses' use of the EHR, while semi-structured interviews with nurses and managers explored their perceptions of the EHR and how it affected their practice. Data were analyzed thematically using codes derived deductively from the literature and inductively from the data.

Results: Key themes arising from the analysis suggest that the EHR changed various elements of the way nurses practiced. Introducing the EHR was thought to have improved communication, ease of access to information and the safety of medication administration processes. At an organizational level, there was variability in how the EHR was used to support care documentation and initiatives to improve the quality of care provided by nurses.

Conclusion: The EHR was perceived to improve efficiency, safety and communication by the majority of nurses who were interviewed. However, it is likely that a number of other factors such as individual nurse's characteristics and organizational culture influence how an EHR can be used effectively to improve outcomes for patients.

• Case site study
• electronic health records
• nursing informatics
• quality of health care

ACKNOWLEDGEMENTS

Support for this research by the lead author was provided by The Commonwealth Fund. The views presented here are those of the author and should not be attributed to The Commonwealth Fund or its directors, officers or staff. Funding for the co-authors was provided by Kaiser Permanente. This work was carried out while the lead author was a Harkness Fellow in Health Care Policy and Practice, Institute of Health Policy/HIT Transformation/Analytics, Kaiser Permanente, Oakland CA. Marilyn Chow and Murray Ross provided support and guidance during the course of this study. Finally and foremost, we are grateful to the nursing leaders and staff who allowed us access and contributed to our understanding of their efforts.

DECLARATION OF INTEREST

The authors have no competing interests to declare.

AUTHORS' CONTRIBUTIONS

D.D. designed the study, collected data, analyzed the data, revised the manuscript, and is the guarantor. M.T. contributed to the analysis and revised the manuscript. T.G. helped design the study, contributed to the analysis and revised the manuscript. All authors had full access to all of the data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. All authors approved the final version of the manuscript.