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Groom LL, Feldthouse D, Robertiello G, Fletcher J, Squires A. A Pilot Study Toward Development of the Digital Literacy, Usability, and Acceptability of Technology Instrument for Healthcare. Comput Inform Nurs 2024:00024665-990000000-00203. [PMID: 38913989 DOI: 10.1097/cin.0000000000001156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
Electronic health record proficiency is critical for health professionals to deliver and document patient care. There is scarce research on this topic within undergraduate nursing student populations. The purpose of this study is to describe the psychometric evaluation of the Digital Literacy, Usability, and Acceptability of Technology Instrument for Healthcare. A cross-sectional pilot study for psychometric evaluation of the instrument was conducted using data collected through an emailed survey. Exploratory factor analysis, inter-item and adjusted item-total correlations, and Cronbach's α calculated subscale reliability. A total of 297 nursing students completed the survey. A seven-factor structure best fit the data: technology use-engagement, technology use-confidence, technology use-history, electronic health record-ease of use, electronic health record-comparability, and electronic health record-burden. Cronbach's α indicated good to very good internal consistency (α = .68 to .89). The instrument effectively measured digital literacy, acceptance, and usability of an electronic health record and may be implemented with good to very good reliability across varied healthcare simulation and training experiences.
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Affiliation(s)
- Lisa L Groom
- Author Affiliations: Quinnipiac University Rory Meyers College of Nursing (Drs Groom, Robertiello, Fletcher, and Squires); and Medical Center Information Technology, NYU Langone Health, New York (Dr Groom and Ms Feldthouse)
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2
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Győrffy Z, Radó N, Pölczman L, Sükösd A, Boros J. Creating work-life balance among physicians in the age of digitalization: the role of self-consciousness and communication - a qualitative study. BMC Health Serv Res 2023; 23:1141. [PMID: 37875908 PMCID: PMC10594792 DOI: 10.1186/s12913-023-10101-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/01/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Besides the positive effects of using digital health solutions, digitalization can affect the healthcare worker burnout. The ability to coordinate different aspects of life (WLB) also plays a significant role in the development of burnout among medical workers. The aim of our study is to show, through qualitative interviews, the impact of digitalization on work-life balance in Hungarian physicians. METHODS 62 semi-structured interviews were conducted between October 2021 and June 2022, of which, a total of 31 interviews were used for the analysis, which were all related to the theme of work-life balance. Purposive sampling and inductive thematic approach were used to collect and analyse the data and identify patterns of the themes. RESULTS Based on this analysis, 5 main themes emerged: (1) the use of digital health tools, (2) Impact of digital tools on everyday work, (3) Work-life balance, (4) Setting and maintaining work-life boundaries, (5) Potential solutions. With the spread of digital communication, most of the respondents feel that their working hours increased even at the expense of their private life. The majority considers constant availability as a serious problem, however, several physicians indicated that as a result of a learning curve, they are able to change and set the necessary boundaries. Respondents were divided on whether or not they were successful in setting and maintaining boundaries. The 2 most important factors of establishing WLB in a digital age are self-consciousness and communication. However, these skills are not self-evident: the responses also show that in many cases there is a need for external support, but also for health professionals to actively reflect from time to time on their role as healers and their relationship with technology. CONCLUSION Basic principles and tools for establishing successful digital work-life balance in healthcare should be involved in the training curriculum of future physicians and healthcare professionals, while institutions should elaborate specific policies to include digital work-life balance in the institutional setting, as part of the preventive measures against burnout.
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Affiliation(s)
- Zsuzsa Győrffy
- Institute of Behavioral Sciences, Faculty of Medicine, Semmelweis University, Nagyvárad tér 4. 20th floor, Budapest, H-1089, Hungary.
| | - Nóra Radó
- Institute of Behavioral Sciences, Faculty of Medicine, Semmelweis University, Nagyvárad tér 4. 20th floor, Budapest, H-1089, Hungary
| | - Lea Pölczman
- Institute of Behavioral Sciences, Faculty of Medicine, Semmelweis University, Nagyvárad tér 4. 20th floor, Budapest, H-1089, Hungary
| | - Anikó Sükösd
- Eötvös Lorand University, Pázmány Péter sétány 1/A, Budapest, H-1117, Hungary
| | - Julianna Boros
- Institute of Behavioral Sciences, Faculty of Medicine, Semmelweis University, Nagyvárad tér 4. 20th floor, Budapest, H-1089, Hungary
- Hungarian Demographic Research Institute, Budapest, Hungary
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Jedwab RM, Manias E, Redley B, Dobroff N, Hutchinson AM. Impacts of technology implementation on nurses' work motivation, engagement, satisfaction and well-being: A realist review. J Clin Nurs 2023; 32:6037-6060. [PMID: 37082879 DOI: 10.1111/jocn.16730] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/27/2023] [Accepted: 04/05/2023] [Indexed: 04/22/2023]
Abstract
AIM To examine current literature for causal explanations on how, why and under what circumstances, implementation of a new hospital electronic medical record system or similar technology impacts nurses' work motivation, engagement, satisfaction or well-being. BACKGROUND Implementation of new technology, such as electronic medical record systems, affects nurses and their work, workflows and inter-personal interactions in healthcare settings. Multiple individual and organisational-level factors can affect technology adoption by nurses and may have negative consequences for nurses and patient safety. DESIGN Five-step realist review method and Realist And Meta-narrative Evidence Syntheses: Evolving Standards checklist was used to guide this review. Eight initial theories (programme theories) were used as the basis to explore, examine and refine literature from a range of sources. DATA SOURCES Literature from five databases (APA PsycInfo, CINAHL, Embase, IEEE Xplore and MEDLINE Complete) and grey literature (from 1 January 2000 to 31 October 2021) were systematically searched and retrieved on 4 November 2021. RESULTS In all, 8980 records were screened at the title and abstract level, of which 1027 full texts were screened and 10 were included in the review. Seven studies assessed concepts in both pre- and post-technology implementation. Most common contexts related to knowledge, rationale and skills to use new technology. Mechanisms that impacted nurses or nursing care delivery included: nurses' involvement in technology implementation processes; nurses' perceptions, understanding and limitations of technology impact(s) on patient care delivery; social supports; skills; implementation attitude and hardware. Work satisfaction was the most frequently examined outcome. An analysis led to nine final programme theories (including two original, six revised and one new programme theory). CONCLUSION Nurses must be informed about the rationale for new technology and have the knowledge and skills for its use. Understanding nurses' work motivation and attitudes related to technology adoption in the workplace can support work engagement, satisfaction and well-being. IMPLICATIONS FOR THE PROFESSION Complex contexts and mechanisms play a role in nurses' work motivation, engagement, satisfaction and well-being with the implementation of new technology into healthcare settings. RELEVANCE TO CLINICAL PRACTICE Nurses, their work and workflows are all influenced by the implementation of new technologies (such as electronic medical records), which in turn has consequences for patient safety and quality of care. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. PROSPERO REGISTRATION NUMBER CRD42020131875 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=131875).
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Affiliation(s)
- Rebecca M Jedwab
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University School of Nursing and Midwifery, Melbourne, Victoria, Australia
- Monash Health Nursing and Midwifery Informatics, Melbourne, Victoria, Australia
| | - Elizabeth Manias
- Institute for Health Transformation, Deakin University School of Nursing and Midwifery, Melbourne, Victoria, Australia
| | - Bernice Redley
- Deakin University School of Nursing and Midwifery, Melbourne, Victoria, Australia
| | - Naomi Dobroff
- Monash Health Nursing and Midwifery Informatics, Melbourne, Victoria, Australia
- Deakin University School of Nursing and Midwifery, Melbourne, Victoria, Australia
| | - Alison M Hutchinson
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University School of Nursing and Midwifery, Melbourne, Victoria, Australia
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Alrasheeday AM, Alshammari B, Alkubati SA, Pasay-an E, Albloushi M, Alshammari AM. Nurses' Attitudes and Factors Affecting Use of Electronic Health Record in Saudi Arabia. Healthcare (Basel) 2023; 11:2393. [PMID: 37685427 PMCID: PMC10486676 DOI: 10.3390/healthcare11172393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/13/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
(1) Background: Nurses' attitudes toward electronic health records (EHRs) is a very valuable issue that needs to be evaluated, understood, and considered one of the main factors that can lead to its improvement or handicap its implementation. This study aimed to assess nurses' attitudes toward EHRs and associated factors that affect the implementation of EHRs in different hospitals in Saudi Arabia. (2) Methods: A cross-sectional study was utilized to collect data from 297 nurses working in public hospitals and primary healthcare centers in Ha'il Province from January to May 2023. Data were collected using the Nurses' Attitudes Towards Computerization questionnaire and a sociodemographic and work-related characteristics sheet. (3) Results: Most of the participants' attitude scores (81.1%, n = 241) were more than or equal to 60, representing positive attitudes, whereas 18.9% (n = 56) of the nurses' scores were less than 60, which is interpreted as negative attitudes. There was a significant relationship between nurses' attitudes toward EHRs and a participants' sex, where males had a more positive attitude than females (p < 0.001). Particularly, young nurses and those who had previous computer experience had a more positive attitude than older nurses and those who had no computer experience (p = 0.044 and < 0.001, respectively). Saudi nurses holding a master's degree had significantly more positive attitudes toward EHRs than non-Saudi nurses holding a bachelor's or diploma degree (p = 0.007 and 0.048, respectively). Nurses with less experience (less than five years) in the nursing field had a significantly positive attitude. Multiple linear regression showed that sex (p = 0.038), level of education (p = 0.001), and previous computer experience (p < 0.001) were independent factors of nurses' knowledge of EHRs. (4) Conclusion: The majority of nurses had positive overall attitudes toward using EHRs. Nurses who are Saudi nationals, male, younger, have previous computer experience, and have less than five years of experience had a more positive attitude toward EHRs than nurses who are non-Saudi, female, older, have no computer experience, have bachelor's or diploma degree, and have less than five years of experience, respectively. Sex, education level, and previous computer experience were independent factors of nurses' knowledge of EHRs.
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Affiliation(s)
- Awatif M. Alrasheeday
- Nursing Administration Department, College of Nursing, University of Hail, Hail 2440, Saudi Arabia;
| | - Bushra Alshammari
- Medical Surgical Nursing Department, College of Nursing, University of Hail, Hail 2440, Saudi Arabia;
| | - Sameer A. Alkubati
- Medical Surgical Nursing Department, College of Nursing, University of Hail, Hail 2440, Saudi Arabia;
- Department of Nursing, Faculty of Medicine and Health Sciences, Hodeida University, Hodeida P.O. Box 3114, Yemen
| | - Eddieson Pasay-an
- Maternal and Child Nursing Department, College of Nursing, University of Hail, Hail 2440, Saudi Arabia;
| | - Monirah Albloushi
- Medical Surgical Department, College of Nursing, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Awayed M. Alshammari
- Nursing Administration, King Khalid General Hospital, Ministry of Health, Hafar Al Batin 39921, Saudi Arabia;
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Nguyen OT, Turner K, Charles D, Sprow O, Perkins R, Hong YR, Islam JY, Khanna N, Alishahi Tabriz A, Hallanger-Johnson J, Bickel Young J, Moore CE. Implementing Digital Scribes to Reduce Electronic Health Record Documentation Burden Among Cancer Care Clinicians: A Mixed-Methods Pilot Study. JCO Clin Cancer Inform 2023; 7:e2200166. [PMID: 36972488 DOI: 10.1200/cci.22.00166] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
PURPOSE To address shortcomings of human scribes (eg, turnover), clinicians are considering digital scribes (DSs). To our knowledge, to date, no study has assessed DS implementation or clinician user experience in cancer centers. We assessed the DS's feasibility, acceptability, appropriateness, usability and its preliminary association on clinician well-being in a cancer center. We also identified implementation facilitators and barriers to DS use. METHODS Using a mixed-methods longitudinal pilot study design, we implemented a DS at a cancer center. Data collection included surveys at baseline and 1 month after DS use and a semistructured interview with clinicians. The survey assessed demographics, Mini Z (workplace stress and burnout), sleep quality, and implementation outcomes (feasibility, acceptability, appropriateness, and usability). The interview assessed how the DS was used and its impacts on workflows and recommendations for future implementations of the DS. We used paired t tests to assess differences in Mini Z and sleep quality measures over time. RESULTS Across nine survey responses and eight interviews, we found that although feasibility scores were slightly lower than our cutoff point (15.2 v 16.0), clinicians rated the DS as marginally acceptable (16.0) and appropriate (16.3). Usability was considered marginally usable (68.6 v 68.0). Although the DS did not significantly improve burnout (3.6 v 3.9, P = .081), it improved perceptions of having sufficient documentation time (2.1 v 3.6, P = .005). Clinicians identified suggestions for future implementations, including training needs and usability improvements. CONCLUSION Our preliminary findings suggest that DS implementation is marginally acceptable, appropriate, and usable among cancer care clinicians. Individualized training and on-site support may improve implementation.
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Affiliation(s)
- Oliver T Nguyen
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Kea Turner
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
- Department of Oncologic Science, University of South Florida, Tampa, FL
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Dannelle Charles
- Participant, Research, Interventions, and Measurement Core, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Olivia Sprow
- Department of Epidemiology, University of Florida, Gainesville, FL
| | - Randa Perkins
- Department of Internal Medicine, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Young-Rock Hong
- Department of Health Services Research, Management, and Policy, Gainesville, FL
| | - Jessica Y Islam
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Neel Khanna
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
- Department of Oncologic Science, University of South Florida, Tampa, FL
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | | | - Jennifer Bickel Young
- Department of Oncologic Science, University of South Florida, Tampa, FL
- Department of Neuro-Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
- Wellness Office, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - Colin E Moore
- Department of Individualized Cancer Management, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
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Alobayli F, O’Connor S, Holloway A, Cresswell K. Electronic Health Record Stress and Burnout Among Clinicians in Hospital Settings: A Systematic Review. Digit Health 2023; 9:20552076231220241. [PMID: 38130797 PMCID: PMC10734365 DOI: 10.1177/20552076231220241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
Background There is growing evidence to suggest that EHRs may be associated with clinician stress and burnout, which could hamper their effective use and introduce risks to patient safety. Objective This systematic review aimed to examine the association between EHR use and clinicians' stress and burnout in hospital settings, and to identify the contributing factors influencing this relationship. Methods The search included peer-reviewed published studies between 2000 and 2023 in English in CINAHL, Ovid Medline, Embase, and PsychINFO. Studies that provided specific data regarding clinicians' stress and/or burnout related to EHRs in hospitals were included. A quality assessment of included studies was conducted. Results Twenty-nine studies were included (25 cross-sectional surveys, one qualitative study, and three mixed methods), which focused on physicians (n = 18), nurses (n = 10) and mixed professions (n = 3). Usability issues and the amount of time spent on the EHR were the most significant predictors, but intensity of the working environment influenced high EHR-related workload and thereby also contributed to stress and burnout. The differences in clinicians' specialties influenced the levels of stress and burnout related to EHRs. Conclusions This systematic review showed that EHR use was a perceived contributor to clinicians' stress and burnout in hospitals, primarily driven by poor usability and excessive time spent on EHRs. Addressing these issues requires tailored EHR systems, rigorous usability testing, support for the needs of different specialities, qualitative research on EHR stressors, and expanded research in Non-Western contexts.
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Affiliation(s)
- Fatimah Alobayli
- Nursing Studies, School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| | - Siobhan O’Connor
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Aisha Holloway
- Nursing Studies, School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| | - Kathrin Cresswell
- College of Medicine and Veterinary Medicine, Usher Institute, The University of Edinburgh, Edinburgh, UK
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Knox MK, Mehta PD, Dorsey LE, Yang C, Petersen LA. A Novel Use of Bar Code Medication Administration Data to Assess Nurse Staffing and Workload. Appl Clin Inform 2023; 14:76-90. [PMID: 36473498 PMCID: PMC9891851 DOI: 10.1055/a-1993-7627] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The aim of the study is to introduce an innovative use of bar code medication administration (BCMA) data, medication pass analysis, that allows for the examination of nurse staffing and workload using data generated during regular nursing workflow. METHODS Using 1 year (October 1, 2014-September 30, 2015) of BCMA data for 11 acute care units in one Veterans Affairs Medical Center, we determined the peak time for scheduled medications and included medications scheduled for and administered within 2 hours of that time in analyses. We established for each staff member their daily peak-time medication pass characteristics (number of patients, number of peak-time scheduled medications, duration, start time), generated unit-level descriptive statistics, examined staffing trends, and estimated linear mixed-effects models of duration and start time. RESULTS As the most frequent (39.7%) scheduled medication time, 9:00 was the peak-time medication pass; 98.3% of patients (87.3% of patient-days) had a 9:00 medication. Use of nursing roles and number of patients per staff varied across units and over time. Number of patients, number of medications, and unit-level factors explained significant variability in registered nurse (RN) medication pass duration (conditional R2 = 0.237; marginal R2 = 0.199; intraclass correlation = 0.05). On average, an RN and a licensed practical nurse (LPN) with four patients, each with six medications, would be expected to take 70 and 74 minutes, respectively, to complete the medication pass. On a unit with median 10 patients per LPN, the median duration (127 minutes) represents untimely medication administration on more than half of staff days. With each additional patient assigned to a nurse, average start time was earlier by 4.2 minutes for RNs and 1.4 minutes for LPNs. CONCLUSION Medication pass analysis of BCMA data can provide health systems a means for assessing variations in staffing, workload, and nursing practice using data generated during routine patient care activities.
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Affiliation(s)
- Melissa K. Knox
- Michael E. DeBakey VA Medical Center, Houston, Texas, United States
- Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas, United States
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States
| | - Paras D. Mehta
- Department of Medicine, University of Houston, Houston, Texas, United States
| | | | - Christine Yang
- Michael E. DeBakey VA Medical Center, Houston, Texas, United States
- Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas, United States
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States
| | - Laura A. Petersen
- Michael E. DeBakey VA Medical Center, Houston, Texas, United States
- Center for Innovations in Quality, Effectiveness, and Safety, Houston, Texas, United States
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States
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Lindroth HL, Pinevich Y, Barwise AK, Fathma S, Diedrich D, Pickering BW, Herasevich V. Information and Data Visualization Needs among Direct Care Nurses in the Intensive Care Unit. Appl Clin Inform 2022; 13:1207-1213. [PMID: 36577501 PMCID: PMC9797346 DOI: 10.1055/s-0042-1758735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Intensive care unit (ICU) direct care nurses spend 22% of their shift completing tasks within the electronic health record (EHR). Miscommunications and inefficiencies occur, particularly during patient hand-off, placing patient safety at risk. Redesigning how direct care nurses visualize and interact with patient information during hand-off is one opportunity to improve EHR use. A web-based survey was deployed to better understand the information and visualization needs at patient hand-off to inform redesign. METHODS A multicenter anonymous web-based survey of direct care ICU nurses was conducted (9-12/2021). Semi-structured interviews with stakeholders informed survey development. The primary outcome was identifying primary EHR data needs at patient hand-off for inclusion in future EHR visualization and interface development. Secondary outcomes included current use of the EHR at patient hand-off, EHR satisfaction, and visualization preferences. Frequencies, means, and medians were calculated for each data item then ranked in descending order to generate proportional quarters using SAS v9.4. RESULTS In total, 107 direct care ICU nurses completed the survey. The majority (46%, n = 49/107) use the EHR at patient hand-off to verify exchanged verbal information. Sixty-four percent (n = 68/107) indicated that current EHR visualization was insufficient. At the start of an ICU shift, primary EHR data needs included hemodynamics (mean 4.89 ± 0.37, 98%, n = 105), continuous IV medications (4.55 ± 0.73, 93%, n = 99), laboratory results (4.60 ± 0.56, 96%, n = 103), mechanical circulatory support devices (4.62 ± 0.72, 90%, n = 97), code status (4.40 ± 0.85, 59%, n = 108), and ventilation status (4.35 + 0.79, 51%, n = 108). Secondary outcomes included mean EHR satisfaction of 65 (0-100 scale, standard deviation = ± 21) and preferred future EHR user-interfaces to be organized by organ system (53%, n = 57/107) and visualized by tasks/schedule (61%, n = 65/107). CONCLUSION We identified information and visualization needs of direct care ICU nurses. The study findings could serve as a baseline toward redesigning an EHR interface.
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Affiliation(s)
- Heidi L. Lindroth
- Department of Nursing, Mayo Clinic, Rochester, Minnesota, United States,Center for Aging Research, Regenstrief Institute, School of Medicine, Indiana University, Indianapolis, Indiana, United States,Address for correspondence Heidi L. Lindroth, PhD RN Department of Nursing, Mayo Clinic200 First Street SW, Rochester, MN 55905United States
| | - Yuliya Pinevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States,Department of Anesthesiology and Intensive Care for Cardiac Surgery, Republican Clinical Medical Center, Belarus
| | - Amelia K. Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Sawsan Fathma
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Daniel Diedrich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Brian W. Pickering
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Vitaly Herasevich
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States
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Khan AR, Rosenthal CD, Ternes K, Sing RF, Sachdev G. Time Spent by Intensive Care Unit Nurses on the Electronic Health Record. Crit Care Nurse 2022; 42:44-50. [PMID: 36180057 DOI: 10.4037/ccn2022518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The amount of time spent on the electronic health record is often cited as a contributing factor to burnout and work-related stress in nurses. Increased electronic health record use also reduces the time nurses have for direct contact with patients and families. There has been minimal investigation into the amount of time intensive care unit nurses spend on the electronic health record. OBJECTIVE To quantify the amount of time spent by intensive care unit nurses on the electronic health record. METHODS In this observational study, active electronic health record use time was analyzed for 317 intensive care unit nurses in a single institution from January 2019 through July 2020. Monthly data on electronic health record use by nurses in the medical, neurosurgical, and surgical-trauma intensive care units were evaluated. RESULTS Full-time intensive care unit nurses spent 28.9 hours per month on the electronic health record, about 17.5% of their clinical shift, for a total of 346.3 hours per year. Part-time nurses and those working as needed spent 20.5 hours per month (17.6%) and 7.4 hours per month (14.2%) on the electronic health record, respectively. Neurosurgical and medical intensive care unit nurses spent 25.0 hours and 19.9 hours per month, respectively. Nurses averaged 23 clicks per minute during use. Most time was spent on the task of documentation at 12.3 hours per month, which was followed by medical record review at 2.6 hours per month. CONCLUSION Intensive care unit nurses spend at least 17% of their shift on the electronic health record, primarily on documentation. Future interventions are necessary to reduce time spent on the electronic health record and to improve nurse and patient satisfaction.
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Affiliation(s)
- Ahsan R Khan
- Ahsan R. Khan is a medical student at the Morehouse School of Medicine in Atlanta, Georgia
| | - Courtney D Rosenthal
- Courtney D. Rosenthal is a registered surgical-trauma intensive care unit nurse and nurse educator, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina
| | - Kelly Ternes
- Kelly Ternes is a registered surgical-trauma intensive care unit nurse, Carolinas Medical Center, Atrium Health
| | - Ronald F Sing
- Ronald F. Sing is an acute care surgeon, Carolinas Medical Center, Atrium Health
| | - Gaurav Sachdev
- Gaurav Sachdev is an acute care surgeon, Carolinas Medical Center, Atrium Health
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Strudwick G, Jeffs L, Kemp J, Sequeira L, Lo B, Shen N, Paterson P, Coombe N, Yang L, Ronald K, Wang W, Pagliaroli S, Tajirian T, Ling S, Jankowicz D. Identifying and adapting interventions to reduce documentation burden and improve nurses' efficiency in using electronic health record systems (The IDEA Study): protocol for a mixed methods study. BMC Nurs 2022; 21:213. [PMID: 35927701 PMCID: PMC9351241 DOI: 10.1186/s12912-022-00989-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/20/2022] [Indexed: 12/02/2022] Open
Abstract
Background Although EHR systems have become a critical part of clinical care, nurses are experiencing a growing burden due to documentation requirements, taking time away from other important clinical activities. There is a need to address the inefficiencies and challenges that nurses face when documenting in and using EHRs. The objective of this study is to engage nurses in generating ideas on how organizations can support and optimize nurses’ experiences with their EHR systems, thereby improving efficiency and reducing EHR-related burden. This work will ensure the identified solutions are grounded in nurses’ perspectives and experiences and will address their specific EHR-related needs. Methods This mixed methods study will consist of three phases. Phase 1 will evaluate the accuracy of the EHR system’s analytics platform in capturing how nurses utilize the system in real-time for tasks such as documentation, chart review, and medication reconciliation. Phase 2 consists of a retrospective analysis of the nursing-specific analytics platform and focus groups with nurses to understand and contextualize their usage patterns. These focus groups will also be used to identify areas for improvement in the utilization of the EHR. Phase 3 will include focus groups with nurses to generate and adapt potential interventions to address the areas for improvement and assess the perceived relevance, feasibility, and impact of the potential interventions. Discussion This work will generate insights on addressing nurses’ EHR-related burden and burnout. By understanding and contextualizing inefficiencies and current practices, opportunities to improve EHR systems for nursing professional practice will be identified. The study findings will inform the co-design and implementation of interventions that will support adoption and impact. Future work will include the evaluation of the developed interventions, and research on scaling and disseminating the interventions for use in different organizations, EHR systems, and jurisdictions in Canada.
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Affiliation(s)
- Gillian Strudwick
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. .,Centre for Complex Interventions, Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, ON, M6J 1H4, Canada. .,Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Lianne Jeffs
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada.,Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Jessica Kemp
- Centre for Complex Interventions, Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, ON, M6J 1H4, Canada
| | - Lydia Sequeira
- Centre for Complex Interventions, Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, ON, M6J 1H4, Canada.,Canada Health Infoway, Toronto, ON, Canada
| | - Brian Lo
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Centre for Complex Interventions, Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, ON, M6J 1H4, Canada.,Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Nelson Shen
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Centre for Complex Interventions, Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, ON, M6J 1H4, Canada
| | | | - Noelle Coombe
- Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Lily Yang
- Quality and Patient Experience, Sinai Health, Toronto, ON, Canada
| | - Kara Ronald
- Professional Practice, Nursing and Health Disciplines, Sinai Health, Toronto, ON, Canada
| | - Wei Wang
- Centre for Complex Interventions, Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, ON, M6J 1H4, Canada
| | | | - Tania Tajirian
- Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sara Ling
- Centre for Complex Interventions, Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, ON, M6J 1H4, Canada
| | - Damian Jankowicz
- Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
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11
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Jedwab RM, Manias E, Hutchinson AM, Dobroff N, Redley B. Nurses’ Experiences After Implementation of an Organization-Wide Electronic Medical Record: Qualitative Descriptive Study. JMIR Nurs 2022; 5:e39596. [PMID: 35881417 PMCID: PMC9328123 DOI: 10.2196/39596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/29/2022] [Accepted: 07/02/2022] [Indexed: 11/28/2022] Open
Abstract
Background Reports on the impact of electronic medical record (EMR) systems on clinicians are mixed. Currently, nurses’ experiences of adopting a large-scale, multisite EMR system have not been investigated. Nurses are the largest health care workforce; therefore, the impact of EMR implementation must be investigated and understood to ensure that patient care quality, changes to nurses’ work, and nurses themselves are not negatively impacted. Objective This study aims to explore Australian nurses’ postimplementation experiences of an organization-wide EMR system. Methods This qualitative descriptive study used focus group and individual interviews and an open-ended survey question to collect data between 12 and 18 months after the implementation of an EMR across 6 hospital sites of a large health care organization in Victoria, Australia. Data were collected between November 2020 and June 2021, coinciding with the COVID-19 pandemic. Analysis comprised complementary inductive and deductive approaches. Specifically, reflexive thematic analysis was followed by framework analysis by the coding of data as barriers or facilitators to nurses’ use of the EMR using the Theoretical Domains Framework. Results A total of 158 nurses participated in this study. The EMR implementation dramatically changed nurses’ work and how they viewed their profession, and nurses were still adapting to the EMR implementation 18 months after implementation. Reflexive thematic analysis led to the development of 2 themes: An unintentional divide captured nurses’ feelings of division related to how using the EMR affected nurses, patient care, and the broader nursing profession. This time, it’s personal detailed nurses’ beliefs about the EMR implementation leading to bigger changes to nurses as individuals and nursing as a profession than other changes that nurses have experienced within the health care organization. The most frequent barriers to EMR use by nurses were related to the Theoretical Domains Framework domain of environmental context and resources. Facilitators of EMR use were most often related to memory, attention, and decision processes. Most barriers and facilitators were related to motivation. Conclusions Nurses perceived EMR implementation to have a mixed impact on the provision of quality patient care and on their colleagues. Implementing technology in a health care setting was perceived as a complex endeavor that impacted nurses’ perceptions of their autonomy, ways of working, and professional roles. Potential negative consequences were related to nursing workforce retention and patient care delivery. Motivation was the main behavioral driver for nurses’ adoption of EMR systems and hence a key consideration for implementing interventions or organizational changes directed at nurses.
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Affiliation(s)
- Rebecca M Jedwab
- Centre for Quality and Patient Safety Research-Monash Health Partnership, Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Melbourne, Australia
- Nursing and Midwifery Informatics, Monash Health, Melbourne, Australia
| | - Elizabeth Manias
- Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Melbourne, Australia
| | - Alison M Hutchinson
- Centre for Quality and Patient Safety Research-Monash Health Partnership, Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Melbourne, Australia
- Nursing and Midwifery, Monash Health, Melbourne, Australia
| | - Naomi Dobroff
- Nursing and Midwifery Informatics, Monash Health, Melbourne, Australia
- School of Nursing and Midwifery, Deakin University, Melbourne, Australia
| | - Bernice Redley
- Centre for Quality and Patient Safety Research-Monash Health Partnership, Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Melbourne, Australia
- Nursing and Midwifery, Monash Health, Melbourne, Australia
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12
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Jedwab RM, Hutchinson AM, Manias E, Calvo RA, Dobroff N, Redley B. Change in nurses’ psychosocial characteristics pre- and post-electronic medical record system implementation coinciding with the SARS-CoV-2 pandemic: pre- and post-cross-sectional surveys. Int J Med Inform 2022; 163:104783. [PMID: 35512624 PMCID: PMC9052633 DOI: 10.1016/j.ijmedinf.2022.104783] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/27/2022] [Accepted: 04/24/2022] [Indexed: 01/07/2023]
Abstract
Background The impacts of electronic medical record implementation on nurses, the largest healthcare workforce, have not been comprehensively examined. Negative impacts on nurses have implications for quality of patient care delivery and workforce retention. Objective To investigate changes in nurses’ well-being, intention to stay, burnout, work engagement, satisfaction, motivation and experience using technology pre- and post-implementation of an organisation-wide electronic medical record in Victoria, Australia. Methods The natural experiment comprised an electronic medical record system implementation across six hospitals of a large tertiary healthcare organisation. Cross-sectional surveys were collected pre-electronic medical record implementation prior to the SARS-CoV-2 pandemic in 2019, and 18-months post-electronic medical record implementation during the pandemic in 2020, and findings compared. Results A total of 942 surveys were analysed (550 pre-electronic medical record (response rate 15.52%) and 392 post-electronic medical record (response rate 9.50%)). Post-electronic medical record, nurses’ work satisfaction (r = 0.23, p=<0.001), intention to stay (r = 0.11, p = 0.001) and well-being (r = 0.17, p=<0.001) decreased. Nurses’ perceived competence increased (r = 0.10, p = 0.002) despite decreased autonomy (r = 0.10, p = 0.003). Two of three dimensions of work engagement worsened (vigour r = 0.13, p=<0.001; dedication r = 0.13, p=<0.001) and all dimensions of burnout increased (exhaustion r = 0.08, p = 0.012, cynicism r = 0.07, p = 0.04 and reduced efficiency r = 0.32, p=<0.001). Nurses reported more burnout symptoms (95% CI 4.6–4.7%, p = 0.036), were less engaged (95% CI 49.6–49.9%, p=<0.001) and career trajectory satisfaction decreased (r = 0.15, p=<0.001). Matched data from 52 nurses showed changes in the same direction for all items except career trajectory satisfaction, hence validated findings from the larger unmatched sample. Conclusions Implementation of an electronic medical record immediately followed by the SARS-CoV-2 pandemic was associated with negative changes in nurses’ well-being, intention to stay, burnout, work engagement and satisfaction.
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Affiliation(s)
- Rebecca M Jedwab
- Deakin University School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, 221 Burwood Highway, Burwood, Melbourne, Victoria 3125 Australia; Monash Health Nursing and Midwifery Informatics, 246 Clayton Road, Clayton, Melbourne, Victoria 3168 Australia.
| | - Alison M Hutchinson
- Deakin University School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, 221 Burwood Highway, Burwood, Melbourne, Victoria 3125 Australia; Monash Health, Nursing and Midwifery, 246 Clayton Road, Clayton, Melbourne, Victoria 3168 Australia.
| | - Elizabeth Manias
- Deakin University School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, 221 Burwood Highway, Burwood, Melbourne, Victoria 3125 Australia.
| | - Rafael A Calvo
- Imperial College Faculty of Engineering, Dyson School of Design Engineering, Imperial College Rd, South Kensington, London SW7 9EG, United Kingdom.
| | - Naomi Dobroff
- Monash Health Nursing and Midwifery Informatics, 246 Clayton Road, Clayton, Melbourne, Victoria 3168 Australia; Deakin University School of Nursing and Midwifery, 221 Burwood Highway, Burwood, Melbourne, Victoria 3125 Australia.
| | - Bernice Redley
- Deakin University School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, 221 Burwood Highway, Burwood, Melbourne, Victoria 3125 Australia; Monash Health, Nursing and Midwifery, 246 Clayton Road, Clayton, Melbourne, Victoria 3168 Australia.
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13
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Jedwab RM, Manias E, Hutchinson AM, Dobroff N, Redley B. Understanding nurses' perceptions of barriers and enablers to use of a new electronic medical record system in Australia: A qualitative study. Int J Med Inform 2021; 158:104654. [PMID: 34883386 DOI: 10.1016/j.ijmedinf.2021.104654] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/13/2021] [Accepted: 11/22/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Electronic medical record system implementations impact nurses, their work and workflows. The aim of this study was to understand nurses' perceptions of barriers and enablers to using a new electronic medical record in an acute hospital environment. METHODS Data were collected just prior to an organisation-wide new electronic medical record implementation at a large tertiary healthcare organization in Victoria, Australia. Sixty-three nurses from five hospital sites participated in 12 focus group interviews. Transcripts were transcribed and deductive content analysis used the 14-domain Theoretical Domains Framework to identify barriers and enablers. RESULTS Coded data mapped to 13 of the 14 domains. Nurse motivation emerged as a dominant theme among both barriers and enablers. Nurses' most common perceived barriers related to emotions (24.1%) and environmental context and resources (21.3%). Conversely, the most common enablers related to social influences (21%) and reinforcement (20.8%). DISCUSSION In addition to effecting changes in their work and workflows, the dominance of nurses' emotional responses reveals the potential for implementation of a new electronic medical record to negatively affect nurses' psychological well-being. Using data aligned to the Theoretical Domains Framework assisted identification of behavior change strategies to target the barriers and enablers perceived by nurses. Strategies aligned with nine behavioral intervention categories are recommended for successful implementation and optimization of an electronic medical record by nurses. CONCLUSIONS Multifaceted strategies targeting multiple behaviors are required to support adoption of the electronic medical record by nurses, and reduce the risk for nurse attrition in the workforce.
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Affiliation(s)
- Rebecca M Jedwab
- Deakin University School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation 221 Burwood Highway, Burwood, Melbourne, Victoria 3125, Australia; Monash Health Nursing and Midwifery Informatics 246 Clayton Road, Clayton, Melbourne, Victoria 3168, Australia.
| | - Elizabeth Manias
- Deakin University School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation 221 Burwood Highway, Burwood, Melbourne, Victoria 3125, Australia.
| | - Alison M Hutchinson
- Deakin University School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation 221 Burwood Highway, Burwood, Melbourne, Victoria 3125, Australia; Monash Health Nursing and Midwifery 246 Clayton Road, Clayton, Melbourne, Victoria 3168, Australia.
| | - Naomi Dobroff
- Monash Health Nursing and Midwifery Informatics 246 Clayton Road, Clayton, Melbourne, Victoria 3168, Australia; Deakin University School of Nursing and Midwifery, 221 Burwood Highway, Burwood, Melbourne, Victoria 3125 Australia.
| | - Bernice Redley
- Deakin University School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation 221 Burwood Highway, Burwood, Melbourne, Victoria 3125, Australia; Monash Health Nursing and Midwifery 246 Clayton Road, Clayton, Melbourne, Victoria 3168, Australia.
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14
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Hong YR, Turner K, Nguyen OT, Alishahi Tabriz A, Revere L. Social Determinants of Health and After-Hours Electronic Health Record Documentation: A National Survey of US Physicians. Popul Health Manag 2021; 25:362-366. [PMID: 34637635 DOI: 10.1089/pop.2021.0212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Identifying patients' social determinants of health (SDoH) can improve patient outcomes but may increase clinicians' documentation time. However, there is limited evidence of how many physicians document SDoH and the associated burden. To address this gap, this study examines documentation of SDoH and after-hours electronic health record (EHR) work among a nationally representative sample of US office-based physicians. This was a cross-sectional analysis of the 2018-2019 National Electronic Health Records Survey. A survey design-adjusted bivariate analysis was used to estimate the prevalence of SDoH documentation and compare this activity between physicians' and practices' characteristics. A modified multivariable Poisson model was used to estimate prevalence ratios of SDoH documentation and after-hours work. The study sample included a weighted sample of 303,389 US physicians (31.5%, female; 72.5%, aged ≥50 years; 48.8% primary care specialty). Of those, 84.3% reported documenting patients' SDoH information. Physicians documenting patients' SDoH tend to be younger (<50 years). Prevalence estimates of after-hours EHR documentation were comparable between physicians recording patients' SDoH and those not (33.7% vs. 33.0%) and this difference did not reach statistical significance in adjusted analysis (adjusted prevalence ratio, 0.94, 95% confidence interval, 0.64-1.39). Thus, documenting patients' SDoH appears to be common among US physicians, and this activity is not associated with after-hours EHR documentation. Future studies should examine how patients' SDoH information is used and its association with patient health outcomes.
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Affiliation(s)
- Young-Rock Hong
- Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA.,UF Health Cancer Center, University of Florida, Gainesville, Florida, USA
| | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA.,Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Oliver T Nguyen
- Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida, USA.,Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA.,Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Lee Revere
- Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
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15
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Jedwab RM, Redley B, Manias E, Dobroff N, Hutchinson AM. How does implementation of an electronic medical record system impact nurses' work motivation, engagement, satisfaction and well-being? A realist review protocol. BMJ Open 2021; 11:e055847. [PMID: 34620677 PMCID: PMC8499349 DOI: 10.1136/bmjopen-2021-055847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Electronic medical record (EMR) systems are used worldwide as repositories for patients' clinical information, providing clinical decision support and increasing visibility of and access to clinical information. While EMR systems facilitate improved healthcare delivery, emerging reports suggest potential detrimental effects on clinician well-being. EMR system implementation influences on nurses' work motivation, engagement, satisfaction and well-being (including burnout) are not well understood, nor have they been examined in relation to contextual factors and mechanisms of action. This paper presents a realist review protocol to examine causal explanations to address the question: How, why and under what circumstances does the implementation of a new hospital EMR system or similar technology impact nurses' work motivation, engagement, satisfaction or well-being? METHODS AND ANALYSIS The five-step method for realist review will be used to identify causal relationships, how the relationships work, for whom and under what circumstances: (1) defining the review scope; (2) developing initial program theories; (3) searching the evidence; (4) selecting and appraising the evidence; (5) extracting and synthesising the data. Initial program theories were developed using scoping review findings and qualitative data collected from nurses pre-EMR and post-EMR. Five databases will be systematically searched from 1 January 2000 to 31 October 2021 (APA PsycInfo, CINAHL, Embase, IEEE Xplore and MEDLINE Complete), and forward and backward citation searching, grey literature searching and literature recommended by the research team. Search results will be screened by two research team members. Data extracted will assist in refining program theories to develop a conceptual model that synthesises how work motivation, engagement, satisfaction and well-being may influence, or be influenced by, an EMR implementation. ETHICS AND DISSEMINATION The larger project has previously obtained low-risk ethics approval. The review will be published in a peer-reviewed journal and reported as per RAMESES guidelines. PROSPERO REGISTRATION NUMBER CRD42020131875.
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Affiliation(s)
- Rebecca M Jedwab
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Melbourne, Victoria, Australia
- Nursing and Midwifery Informatics, Monash Health, Melbourne, Victoria, Australia
| | - Bernice Redley
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Melbourne, Victoria, Australia
- Nursing and Midwifery, Monash Health, Melbourne, Victoria, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Melbourne, Victoria, Australia
| | - Naomi Dobroff
- Nursing and Midwifery Informatics, Monash Health, Melbourne, Victoria, Australia
- School of Nursing and Midwifery, Deakin University, Melbourne, Victoria, Australia
| | - Alison M Hutchinson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Melbourne, Victoria, Australia
- Nursing and Midwifery, Monash Health, Melbourne, Victoria, Australia
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16
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Melnick ER, West CP, Nath B, Cipriano PF, Peterson C, Satele DV, Shanafelt T, Dyrbye LN. The association between perceived electronic health record usability and professional burnout among US nurses. J Am Med Inform Assoc 2021; 28:1632-1641. [PMID: 33871018 PMCID: PMC8324227 DOI: 10.1093/jamia/ocab059] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/05/2021] [Accepted: 03/11/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To measure nurse-perceived electronic health records (EHR) usability with a standardized metric of technology usability and evaluate its association with professional burnout. METHODS A cross-sectional survey of a random sample of US nurses was conducted in November 2017. EHR usability was measured with the System Usability Scale (SUS; range 0-100) and burnout with the Maslach Burnout Inventory. RESULTS Among the 86 858 nurses who were invited, 8638 (9.9%) completed the survey. The mean nurse-rated EHR SUS score was 57.6 (SD 16.3). A score of 57.6 is in the bottom 24% of scores across previous studies and categorized with a grade of "F." On multivariable analysis adjusting for age, gender, race, ethnicity, relationship status, children, highest nursing-related degree, mean hours worked per week, years of nursing experience, advanced certification, and practice setting, nurse-rated EHR usability was associated with burnout with each 1 point more favorable SUS score and associated with a 2% lower odds of burnout (OR 0.98; 95% CI, 0.97-0.99; P < .001). CONCLUSIONS Nurses rated the usability of their current EHR in the low marginal range of acceptability using a standardized metric of technology usability. EHR usability and the odds of burnout were strongly associated with a dose-response relationship.
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Affiliation(s)
- Edward R Melnick
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Colin P West
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Bidisha Nath
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Pamela F Cipriano
- Office of the Dean, University of Virginia School of Nursing, Charlottesville, Virginia, USA
- American Nurses Association, Silver Spring, Maryland, USA
| | | | - Daniel V Satele
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tait Shanafelt
- Department of Medicine, Stanford School of Medicine, Palo Alto, California, USA
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