Nurses' views on the use, quality and user satisfaction with electronic medical records: questionnaire development

Nurses' perception of the use of computerised information systems in practice: questionnaire development

AIM

To develop and validate a questionnaire to explore the perceptions of nurses about the implementation of a computerised information system in clinical practice.

BACKGROUND

A growing interest in understanding nurses' experience of developing and implementing clinically relevant Information Technology systems and the lack of measurement tools in this area, justifies further research into the development of instruments to provide an insight into nurses' experience.

DESIGN

Survey and questionnaire development.

METHOD

An initial draft of the questionnaire was developed based on the literature and expert opinion. The questionnaire was piloted by ten nurses to check face validity, reliability and test-retest reliability. A revised version of the questionnaire was distributed to nurses working in the in-patient area of a university hospital in Spain (n = 227). Principal components analysis with oblique rotation was carried out to test theoretically developed underlying dimensions and to test construct validity. Cronbach's alpha coefficient was used to determine internal consistency.

RESULTS

Cronbach's alpha for all the items included in the different scales was 0.88 in the pilot questionnaire and test-retest reliability was adequate. Principal components analysis of items related to mechanisms produced a three-component structure ('IT support', 'usability' and 'information characteristics'). The three factors explained 48.6% of the total variance and Cronbach's alpha ranged from 0.66-0.79. Principal components analysis of items related to outcomes produced a three factor solution ('impact on patient care', 'impact on communication' and 'image profile'). The factors explained 65.9% of the total variance and Cronbach's alpha ranged from 0.64-0.85.

CONCLUSION

The study provides a detailed description and justification of an instrument development process. The instrument is valid and reliable for the setting where it has been used.

RELEVANCE TO CLINICAL PRACTICE

The instrument could provide insight into nurses' experience of IT implementation that will guide further development of systems to enhance clinical practice.

Validation of a professionals' satisfaction questionnaire with electronic medical records (PSQ-EMR) in psychiatry

BACKGROUND

Electronic medical records (EMR) are currently being implemented in psychiatric hospitals throughout Europe. The perceptions of health care professionals can contribute important information that may predict their acceptance of and desired mode of use for EMR, thus guiding EMR implementation.

AIMS

To develop a self-administered instrument designed to assess health care professionals' satisfaction regarding EMR in a psychiatric hospital, based only on the professional point of view, according to the psychometric standards.

METHODS

The development was supervised by a steering committee and undertaken by three standard steps. Item generation was derived from 115 face-to-face interviews with health care professionals in a French, public, psychiatric hospital. The item-reduction process resulted in a 25-item questionnaire. The validation process was based on construct validity, reliability and some aspects of external validity.

RESULTS

The final version of the questionnaire contained 25 items that described five dimensions, leading to a global score. The factor structure accounted for 72% of the total variance. Internal consistency was satisfactory (item-internal consistency over 0.40 and Cronbach's alpha coefficients ranged from 0.86 to 0.95). The scalability was satisfactory with INFIT statistics inside an acceptable range. Scores of dimensions were strongly positively correlated with visual analogue scale scores (all p < 0.001). External validity showed statistical associations between scores and age, gender, seniority in psychiatry and ward type. Participation rate was 66%.

CONCLUSION

The availability of a reliable and valid questionnaire (professionals' satisfaction questionnaire with electronic medical records [PSQ-EMR]) concerning health care professionals' satisfaction regarding EMR in psychiatry, exclusively generated from interviews with health care professionals, enables legitimate feedback to be incorporated into EMR implementation in order to formulate a high-quality health care.