Development and Psychometric Qualities of the SEIPS Survey to Evaluate CPOE/EHR Implementation in ICUs

Empathic Care Culture in Intensive Care Unit Nurses: A Focused Ethnographic Study

Empathy is one of the important components in the patient-nurse relationship. The aim of the study was to explain the culture of empathic care in intensive care unit (ICU) nurses. The present focused ethnographic study was conducted in the cardiac surgery ICU in Tehran. Three methods of observation, interview, and review of existing documents were used to collect data. From data analysis, three cultural models, "Predominance of task-based care over emotion-based care," "Empathy and lack of empathy, two ends of the spectrum of the nurse-patient relationship," and "Empathy, an interactive and reciprocal process," were extracted. The results showed that empathy creates a caring environment where nurses not only understand their patients but also relate to them, and both are affected by it. Policymakers should consider removing barriers as a means of empowering nurses to provide empathic care.

Development and Validation of SafeHIT: An Instrument to Assess the Self-Reported Safe Use of Health Information Technology

BACKGROUND

Implementing health information technology (HIT) may cause unintended consequences and safety risks when incorrectly designed and used. Yet, the tools to assess self-reported safe use of HIT are not well established.

OBJECTIVE

This study aims to develop and validate SafeHIT, an instrument to assess self-reported safe use of HIT among health care practitioners.

METHODS

Systematic literature review and a semistructured interview with 31 experts were adopted to generate SafeHIT instrument items. In total, 450 physicians from various departments at three Malaysian public hospitals participated in the questionnaire survey to validate SafeHIT. Exploratory factor analysis and confirmatory factor analysis (CFA) were undertaken to explore the items that best represent a specific construct and to confirm the reliability and validity of the SafeHIT, respectively.

RESULTS

The final SafeHIT consisted of 14 constructs and 58 items in total. The result of the CFA confirmed that all constructs demonstrated adequate convergent and discriminant validity.

CONCLUSION

A reliable and valid theoretically underpinned measure of determinants of safe HIT use behavior has been developed. Understanding external factors that influence safe HIT use is useful for developing targeted interventions that favor the quality and safety of health care.

A Systematic Review of the Consumer Emergency Care Satisfaction Scale (CECSS)

BACKGROUND

Patient experience is receiving increasing attention in the context of patient-centered care. However, there are relatively few instruments that measure patient experience that are valid and reliable.

OBJECTIVE

In this study, we systematically review the literature on the Consumer Emergency Care Satisfaction Scale (CECSS) and examine its psychometric properties.

METHODS

We conducted a systematic literature search in the Cumulative Index to Nursing and Allied Health Literature, PubMed, PsycINFO, and Web of Science databases on articles that contain information on the CECSS. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

Our systematic literature search resulted in 28 articles in which the CECSS was used.

CONCLUSIONS

Results of our literature review show that from a psychometric perspective, the CECSS is a valid and reliable instrument. However, the results of our study also show that the CECSS has several weaknesses. We have made recommendations to improve the CECSS.

Provider Experiences With Offering Families Bedside Health Record Access Across a Children's Hospital

OBJECTIVES

Evaluate provider experiences with a bedside tablet inpatient portal application given to hospitalized patients and families across a children's hospital.

METHODS

In this cross-sectional study, English-speaking parents of children <12 years old and adolescents ≥12 years admitted between February and June 2017 to a 111-bed tertiary children's hospital were given an inpatient portal application (MyChart Bedside; Epic Systems Corporation, Verona, WI) on a tablet (iPad) to use during their stay. The portal included real-time vital signs, test results, medication and problem lists, a daily schedule, educational materials, and provider names and photographs. Portal use was described from electronic health record data, and provider (physician, nurse, and pharmacist) experiences were assessed from surveys.

RESULTS

Of 1892 admissions given a tablet over 5 months, 1502 (79.4%) logged in to view their inpatient health record at least once during their hospital stay. No tablets were lost or stolen. Of 101 providers, 96 completed the survey (a response rate of 95%). They reported that patients and/or parents asked them questions about information they found, including laboratory results (45% of respondents), medications (13%), diagnoses (13%), and errors and/or mistakes in care (3%). Few perceived spending more time answering questions related to portal use (8%) or that it increased their workload (11%). In all, 92% of providers wanted patients and parents to continue to be able to use the portal.

CONCLUSIONS

Almost 80% of hospitalized patients and parents given a tablet accessed real-time information from the inpatient health record. The portal facilitated communication about test results, diagnoses, and medications and providers overwhelmingly supported its ongoing use.

Evaluating the Efficacy of a Mobile, Augmented Reality Pediatric Code Cart Education Application

Pediatric codes are rare events that require fast intervention from medical professionals to resuscitate a child. A pediatric code cart contains all medications and equipment immediately needed to complete a pediatric resuscitation, but not all health care professionals (HCPs) know what is located on the cart and where. A mobile, augmented reality (AR) application was created to improve this knowledge. Ten participants performed a timed search on the cart while wearing Tobii Pro eye tracking glasses before and after exposure to the application. Also, a survey to assess participants’ confidence using the code cart was administered before and after exposure to the application; the post survey also contained usability and satisfaction scales. The results showed that performance and confidence improved after using the application, and that the application usability is acceptable. Our findings suggest the application is useful for improving knowledge and efficiency while working with a pediatric code cart.

Perceived Professional and Institutional Factors Influencing Clinical Adoption of Pharyngeal High-Resolution Manometry

Purpose We assessed experienced clinicians' perceptions of benefits and drawbacks to the clinical adoption of pharyngeal high-resolution manometry (HRM). This article focuses on the professional and institutional factors that influence the clinical adoption of pharyngeal HRM by speech-language pathologists (SLPs). Method Two surveys (closed- and open-ended questions) and a series of focus groups were completed with SLP members of both the American Speech-Language-Hearing Association and the Dysphagia Research Society (DRS). Transcripts were inductively coded for emergent themes. Results Thirteen SLPs were recruited to attend focus group sessions at the American Speech-Language-Hearing Association. Eighty-seven SLPs responded to the DRS open-set response survey. Two additional focus groups of 11 SLPs were convened at the DRS meeting. Conventional content analysis revealed overall SLP enthusiasm for the clinical use of HRM, with some concerns about the technology adoption process. The following themes related to the professional and institutional factors influencing clinical adoption were identified: (a) scope of practice, (b) access, (c) clinical workflow, and (d) reimbursement. Conclusion These data serve to elucidate the most salient factors relating to the clinical adoption of pharyngeal HRM into routine speech-language pathology clinical practice. While enthusiasm exists, a variety of systems-level issues must be addressed to support this process.

Nurses' Expectations of an Inpatient Portal for Hospitalized Patients and Caregivers

BACKGROUND

Patient portals are intended to engage patients and enhance patient-centered care. Recent studies suggest that the information within portals could provide benefits to patients and their caregivers during hospitalization; however, few studies have examined nurse and staff expectations of portals when used in the hospital setting.

OBJECTIVE

This article examines inpatient nurse and support staff expectations of a commercially available inpatient portal prior to its hospital-wide implementation.

METHODS

In this cross-sectional study, nurses and support staff were surveyed 1 month prior to the implementation of an inpatient portal for patients. Items included respondent characteristics, satisfaction with online inpatient portal training, expectations of the effects of portal use on patients, caregivers, and staff, overall acceptance, and barriers to its implementation.

RESULTS

Of 881 respondents, 73.0% were staff nurses, 18.4% nurse assistants, 4.3% unit coordinators, and 1.2% nurse managers. Respondents were generally satisfied with the portal information they received from online training. A majority liked the portal to some extent prior to its use (66.7%); however, they noted multiple implementation barriers, including: tablets would get lost/damaged (66.2% of respondents), patients and/or caregivers would have too many questions (48.5%), and staff would have problems integrating it into their workflow (44.7%). Respondents working on medical units had higher expectations (p < 0.001) and acceptance (p < 0.01) of the portal than those on surgical and intensive care units. Nurse managers were more positive than respondents with other job roles were (all p < 0.001).

CONCLUSION

Overall, nurse and support staff had high expectations of the effects of inpatient portal use prior to its hospital-wide implementation. They thought it would benefit patients and/or their caregivers; however, they also perceived several barriers to its implementation. These results will be used in conjunction with patient and caregiver perspectives to inform future efforts to evaluate and improve upon inpatient portal implementation and dissemination across health systems.

Improving Care Transitions Across Healthcare Settings Through a Human Factors Approach

After more than two decades of research focused on care transition improvement and intervention development, unfavorable outcome measures associated with care transitions across healthcare settings persist. Readmissions rates remain an important outcome to target for intervention, adverse events associated with care transitions continue to be an issue, and patients are often dissatisfied with the quality of their care. Currently, interventions to improve care transitions are disease specific, require substantial financial investments in training allied healthcare professionals, or focus primarily on hospital-based discharge planning with mixed results. This complex situation requires a method of evaluation that can provide a comprehensive, in-depth, and context-driven investigation of potential risks to safe care transitions across healthcare settings, which can lead to the creation of effective, usable, and sustainable interventions. A systems' approach known as Human Factors and Ergonomics (HFE) evaluates the factors in a system that affect human performance. This article describes how HFE can complement and further strengthen efforts to improve care transitions.

Healthcare Team Perceptions of a Portal for Parents of Hospitalized Children Before and After Implementation

BACKGROUND

Patient electronic health record (EHR) portals can enhance patient and family engagement by providing information and a way to communicate with their healthcare team (HCT). However, portal implementation has been limited to ambulatory settings and met with resistance from HCTs.

OBJECTIVE

We evaluated HCT perceptions before and 6-months after implementation of an inpatient EHR portal application on a tablet computer given to parents of hospitalized children.

METHODS

This repeated cross-sectional study was conducted with HCT members (nurses, physicians, ancillary staff) on a medical/surgical unit at a quaternary children's hospital. From December 2014-June 2015, parents of children <12 years old were given a portal application on a tablet computer. It provided real-time vitals, medications, lab results, schedules, education, HCT information and a way to send the HCT messages/requests. HCT members completed surveys pre- and post-implementation regarding their portal perceptions. Pre-post differences in HCT perceptions were compared using chi-squared, Mann-Whitney and Kruskall Wallis tests.

RESULTS

Pre-implementation, HCT respondents (N=94) were generally optimistic about the benefits of a portal for parents; however, all anticipated challenges to portal use. Over the next 6-months, 296 parents used the portal, sending 176 requests and 36 messages. Post-implementation, HCT respondent (N=70) perceptions of these challenges were significantly reduced (all p<0.001), including: parents (will) have too many questions (69 vs. 3%, pre-post), parents (will) know results before the HCT (65 vs. 1%), staff (would be/are) skeptical (43 vs. 21%) and there (will be/is) not enough technical support (28 vs. 1%).

CONCLUSIONS

All HCT respondents anticipated challenges in providing a portal to parents of hospitalized children; however, these concerns were minimized after implementation.

Mind the Gap. A systematic review to identify usability and safety challenges and practices during electronic health record implementation

OBJECTIVE

Decisions made during electronic health record (EHR) implementations profoundly affect usability and safety. This study aims to identify gaps between the current literature and key stakeholders' perceptions of usability and safety practices and the challenges encountered during the implementation of EHRs.

MATERIALS AND METHODS

Two approaches were used: a literature review and interviews with key stakeholders. We performed a systematic review of the literature to identify usability and safety challenges and best practices during implementation. A total of 55 articles were reviewed through searches of PubMed, Web of Science and Scopus. We used a qualitative approach to identify key stakeholders' perceptions; semi-structured interviews were conducted with a diverse set of health IT stakeholders to understand their current practices and challenges related to usability during implementation. We used a grounded theory approach: data were coded, sorted, and emerging themes were identified. Conclusions from both sources of data were compared to identify areas of misalignment.

RESULTS

We identified six emerging themes from the literature and stakeholder interviews: cost and resources, risk assessment, governance and consensus building, customization, clinical workflow and usability testing, and training. Across these themes, there were misalignments between the literature and stakeholder perspectives, indicating major gaps.

DISCUSSION

Major gaps identified from each of six emerging themes are discussed as critical areas for future research, opportunities for new stakeholder initiatives, and opportunities to better disseminate resources to improve the implementation of EHRs.

CONCLUSION

Our analysis identified practices and challenges across six different emerging themes, illustrated important gaps, and results suggest critical areas for future research and dissemination to improve EHR implementation.

Usability problems do not heal by themselves: National survey on physicians' experiences with EHRs in Finland

PURPOSE

Survey studies of health information systems use tend to focus on availability of functionalities, adoption and intensity of use. Usability surveys have not been systematically conducted by any healthcare professional groups on a national scale on a repeated basis. This paper presents results from two cross-sectional surveys of physicians' experiences with the usability of currently used EHR systems in Finland. The research questions were: To what extent has the overall situation improved between 2010 and 2014? What differences are there between healthcare sectors?

METHODS

In the spring of 2014, a survey was conducted in Finland using a questionnaire that measures usability and respondents' user experiences with electronic health record (EHR) systems. The survey was targeted to physicians who were actively doing clinical work. Twenty-four usability-related statements, that were identical in 2010 and 2014, were analysed from the survey. The respondents were also asked to give an overall rating of the EHR system they used. The study data comprised responses from 3081 physicians from the year 2014 and from 3223 physicians in the year 2010, who were using the nine most commonly used EHR system brands in Finland.

RESULTS

Physicians' assessments of the usability of their EHR system remain as critical as they were in 2010. On a scale from 1 ('fail') to 7 ('excellent') the average of overall ratings of their principally used EHR systems varied from 3.2 to 4.4 in 2014 (and in 2010 from 2.5 to 4.3). The results show some improvements in the following EHR functionalities and characteristics: summary view of patient's health status, prevention of errors associated with medication ordering, patient's medication list as well as support for collaboration and information exchange between the physician and the nurses. Even so, support for cross-organizational collaboration between physicians and for physician-patient collaboration were still considered inadequate. Satisfaction with technical features had not improved in four years. The results show marked differences between the EHR system brands as well as between healthcare sectors (private sector, public hospitals, primary healthcare). Compared to responses from the public sector, physicians working in the private sector were more satisfied with their EHR systems with regards to statements about user interface characteristics and support for routine tasks. Overall, the study findings are similar to our previous study conducted in 2010.

CONCLUSIONS

Surveys about the usability of EHR systems are needed to monitor their development at regional and national levels. To our knowledge, this study is the first national eHealth observatory questionnaire that focuses on usability and is used to monitor the long-term development of EHRs. The results do not show notable improvements in physician's ratings for their EHRs between the years 2010 and 2014 in Finland. Instead, the results indicate the existence of serious problems and deficiencies which considerably hinder the efficiency of EHR use and physician's routine work. The survey results call for considerable amount of development work in order to achieve the expected benefits of EHR systems and to avoid technology-induced errors which may endanger patient safety. The findings of repeated surveys can be used to inform healthcare providers, decision makers and politicians about the current state of EHR usability and differences between brands as well as for improvements of EHR usability. This survey will be repeated in 2017 and there is a plan to include other healthcare professional groups in future surveys.

Using an inpatient portal to engage families in pediatric hospital care

OBJECTIVE

Assess parent use and perceptions of an inpatient portal application on a tablet computer that provides information about a child's hospital stay.

METHODS

This cross-sectional study was conducted with parents of children hospitalized on a medical/surgical unit at a tertiary children's hospital. From December 2014 to June 2015, parents were provisioned a tablet portal application to use throughout the hospitalization. The portal includes real-time hospital vitals, medications, schedules, lab results, education, health care team pictures/roles, and request and messaging functionalities. Portal use information was gathered from tablet metadata. Parents completed discharge surveys on portal satisfaction, use, and impact on their information needs, engagement, communication, error detection, and care safety and quality. Data were analyzed using descriptive statistics and qualitative content analysis.

RESULTS

Over 6 months, 296 parents used the portal, sending 176 requests and 36 messages. No tablets were lost or damaged. The most used and liked features included vitals, medication list, health care team information, and schedules. Overall, parent survey respondents (90) were satisfied with the portal (90%), reporting that it was easy to use (98%), improved care (94%), and gave them access to information that helped them monitor, understand, make decisions, and care for their child. Many parents reported that portal use improved health care team communication (60%). Most perceived that portal use reduced errors in care (89%), with 8% finding errors in their child's medication list.

CONCLUSIONS

Overall, parents were satisfied with the inpatient portal. Portals may engage parents in hospital care, facilitate parent recognition of medication errors, and improve perceptions of safety and quality.

Provider Attitudes Toward the Implementation of Clinical Decision Support Tools in Dental Practice

PURPOSE

The objective of this paper is to assess clinical dental providers' baseline knowledge and attitudes about the implementation of three clinical decision support (CDS) tools built into the electronic health record (EHR) of a multi-specialty group dental practice.

PROCEDURES

An electronic survey designed to examine predisposing factors for acceptance of EHR-based tools, caries and periodontal disease management by risk assessment and a risk assessment-based Proactive Dental Care Plan, was distributed to all Willamette Dental Group (WDG) employees. The survey collected demographic data, along with measures of job experience and satisfaction, comfort with dental information technology, and attitudes and knowledge of each CDS tool. WDG provided data on site-level patient and financing mix, patient satisfaction data, employee role (e.g. dentist) and tenure with company. The survey was conducted 3 months prior to the rollout of the CDS tools in November 2013. The survey was distributed electronically to all WDG employees (n = 1166), of whom 58.5% (n = 682) were clinicians, located in 53 sites in Oregon, Washington and Idaho. The overall response rate was 79.8% (n = 930), with a response rate of 83.1% (n = 567) from all clinicians. Of these, 24.3% were general and specialist dentists (n = 138); 26.6% were dental hygienists (n = 151), and 49% were dental assistants (n = 278).

PRINCIPAL FINDINGS

The clinicians surveyed reported being highly amenable to implementation of the three CDS tools. Clinicians' attitudes reflected higher expected improvement in patient care and quality than in business processes due to the implementation. The clinician characteristics most strongly correlated with a positive attitude toward the CDS tool implementation (as measured on Likert scale 1 = low to 5 = high) included satisfaction with the EHR (0.499, p < 0.001), job satisfaction (0.458, p < 0.001), finding change to be exciting (0.398, p < 0.001), degree of control perceived over work (0.352, p < 0.001), and a perception of having adequate tools to get work done (0.340, p < 0.001). Higher reported frequency (scale 1 = never, 7 = always) of feeling burned out (-0.297, p < 0.001), feeling emotionally drained (-0.265, p < 0.001), and feeling work is a strain (-0.205, p < 0.001) had the greatest correlation with negative attitudes.

CONCLUSION

This is the first study to examine dental provider attitudes toward the implementation of CDS tools incorporated within an electronic health record. Provider attitudes toward CDS tools can shape the entire implementation process for better or worse. This study contributes to the literature by providing an understanding of factors related to positive attitudes at the outset of a system change and can help guide organizational administrators to better prepare their workforce and organization for adoption of evidence-based dentistry tools such as a CDS system.

Human factors systems approach to healthcare quality and patient safety

Human factors systems approaches are critical for improving healthcare quality and patient safety. The SEIPS (Systems Engineering Initiative for Patient Safety) model of work system and patient safety is a human factors systems approach that has been successfully applied in healthcare research and practice. Several research and practical applications of the SEIPS model are described. Important implications of the SEIPS model for healthcare system and process redesign are highlighted. Principles for redesigning healthcare systems using the SEIPS model are described. Balancing the work system and encouraging the active and adaptive role of workers are key principles for improving healthcare quality and patient safety.

Macroergonomics in Healthcare Quality and Patient Safety

The US Institute of Medicine and healthcare experts have called for new approaches to manage healthcare quality problems. In this chapter, we focus on macroergonomics, a branch of human factors and ergonomics that is based on the systems approach and considers the organizational and sociotechnical context of work activities and processes. Selected macroergonomic approaches to healthcare quality and patient safety are described such as the SEIPS model of work system and patient safety and the model of healthcare professional performance. Focused reviews on job stress and burnout, workload, interruptions, patient-centered care, health IT and medical devices, violations, and care coordination provide examples of macroergonomics contributions to healthcare quality and patient safety. Healthcare systems and processes clearly need to be systematically redesigned; examples of macroergonomic approaches, principles and methods for healthcare system redesign are described. Further research linking macroergonomics and care processes/patient outcomes is needed. Other needs for macroergonomics research are highlighted, including understanding the link between worker outcomes (e.g., safety and well-being) and patient outcomes (e.g., patient safety), and macroergonomics of patient-centered care and care coordination.

Changes in end-user satisfaction with Computerized Provider Order Entry over time among nurses and providers in intensive care units

BACKGROUND

Implementation of Computerized Provider Order Entry (CPOE) has many potential advantages. Despite the potential benefits of CPOE, several attempts to implement CPOE systems have failed or met with high levels of user resistance. Implementation of CPOE can fail or meet high levels of user resistance for a variety of reasons, including lack of attention to users' needs and the significant workflow changes required by CPOE. User satisfaction is a critical factor in information technology implementation. Little is known about how end-user satisfaction with CPOE changes over time.

OBJECTIVE

To examine ordering provider and nurse satisfaction with CPOE implementation over time.

METHODS

We conducted a repeated cross-sectional questionnaire survey in four intensive care units of a large hospital. We analyzed the questionnaire data as well as the responses to two open-ended questions about advantages and disadvantages of CPOE.

RESULTS

Users were moderately satisfied with CPOE and there were interesting differences between user groups: ordering providers and nurses. User satisfaction with CPOE did not change over time for providers, but it did improve significantly for nurses. Results also show that nurses and providers are satisfied with different aspects of CPOE.

Sociotechnical systems approach to healthcare quality and patient safety

The SEIPS (Systems Engineering Initiative for Patient Safety) model of work system and patient safety is described and selected research and practical applications are presented.

MEASURING WORKLOAD OF ICU NURSES WITH A QUESTIONNAIRE SURVEY: THE NASA TASK LOAD INDEX (TLX)

High workload of nurses in Intensive Care Units (ICUs) has been identified as a major patient safety and worker stress problem. However, relative little attention has been dedicated to the measurement of workload in healthcare. The objectives of this study are to describe and examine several methods to measure workload of ICU nurses. We then focus on the measurement of ICU nurses' workload using a subjective rating instrument: the NASA TLX.We conducted secondary data analysis on data from two, multi-side, cross-sectional questionnaire studies to examine several instruments to measure ICU nurses' workload. The combined database contains the data from 757 ICU nurses in 8 hospitals and 21 ICUs.Results show that the different methods to measure workload of ICU nurses, such as patient-based and operator-based workload, are only moderately correlated, or not correlated at all. Results show further that among the operator-based instruments, the NASA TLX is the most reliable and valid questionnaire to measure workload and that NASA TLX can be used in a healthcare setting. Managers of hospitals and ICUs can benefit from the results of this research as it provides benchmark data on workload experienced by nurses in a variety of ICUs.

Factors contributing to an increase in duplicate medication order errors after CPOE implementation

OBJECTIVE

To evaluate the incidence of duplicate medication orders before and after computerized provider order entry (CPOE) with clinical decision support (CDS) implementation and identify contributing factors.

DESIGN

CPOE with duplicate medication order alerts was implemented in a 400-bed Northeastern US community tertiary care teaching hospital. In a pre-implementation post-implementation design, trained nurses used chart review, computer-generated reports of medication orders, provider alerts, and staff reports to identify medication errors in two intensive care units (ICUs).

MEASUREMENT

Medication error data were adjudicated by a physician and a human factors engineer for error stage and type. A qualitative analysis of duplicate medication ordering errors was performed to identify contributing factors.

RESULTS

Data were collected for 4147 patient-days pre-implementation and 4013 patient-days post-implementation. Duplicate medication ordering errors increased after CPOE implementation (pre: 48 errors, 2.6% total; post: 167 errors, 8.1% total; p<0.0001). Most post-implementation duplicate orders were either for the identical order or the same medication. Contributing factors included: (1) provider ordering practices and computer availability, for example, two orders placed within minutes by different providers on rounds; (2) communication and hand-offs, for example, duplicate orders around shift change; (3) CDS and medication database design, for example confusing alert content, high false-positive alert rate, and CDS algorithms missing true duplicates; (4) CPOE data display, for example, difficulty reviewing existing orders; and (5) local CDS design, for example, medications in order sets defaulted as ordered.

CONCLUSIONS

Duplicate medication order errors increased with CPOE and CDS implementation. Many work system factors, including the CPOE, CDS, and medication database design, contributed to their occurrence.

ICU nurses' acceptance of electronic health records

OBJECTIVE

To assess intensive care unit (ICU) nurses' acceptance of electronic health records (EHR) technology and examine the relationship between EHR design, implementation factors, and nurse acceptance.

DESIGN

The authors analyzed data from two cross-sectional survey questionnaires distributed to nurses working in four ICUs at a northeastern US regional medical center, 3 months and 12 months after EHR implementation.

MEASUREMENTS

Survey items were drawn from established instruments used to measure EHR acceptance and usability, and the usefulness of three EHR functionalities, specifically computerized provider order entry (CPOE), the electronic medication administration record (eMAR), and a nursing documentation flowsheet.

RESULTS

On average, ICU nurses were more accepting of the EHR at 12 months as compared to 3&emsp14;months. They also perceived the EHR as being more usable and both CPOE and eMAR as being more useful. Multivariate hierarchical modeling indicated that EHR usability and CPOE usefulness predicted EHR acceptance at both 3 and 12 months. At 3 months postimplementation, eMAR usefulness predicted EHR acceptance, but its effect disappeared at 12 months. Nursing flowsheet usefulness predicted EHR acceptance but only at 12 months.

CONCLUSION

As the push toward implementation of EHR technology continues, more hospitals will face issues related to acceptance of EHR technology by staff caring for critically ill patients. This research suggests that factors related to technology design have strong effects on acceptance, even 1&emsp14;year following the EHR implementation.