A Comparison of Nurse Attitudes Before Implementation and 6 and 18 Months After Implementation of an Electronic Health Record

Abstract

The implementation of an electronic health record is a dramatic change in a healthcare organization; however, little is known about how nurse attitudes toward the electronic health record change over time. The purpose of this research project was to compare nurses' attitudes before and at 6 and 18 months after implementation of a comprehensive electronic health record. A presurvey-postsurvey design using a modified Nurses' Attitudes Toward Computerization Questionnaire was implemented with a population of nurses employed at an academic medical center. On average, the nurses' attitude about the electronic health record became less positive between preimplementation (n = 312) and 6 months after implementation (n = 410) (74.2 vs 65.9, P < .0001) and preimplementation and 18 months after implementation (n = 262) groups (74.2 vs 67.7, P < .0001). No significant improvement between 6 and 18 months after implementation groups (P = .16) was noted. Prior to electronic health record implementation, the nurses were uncertain yet hopeful about the benefits. However, 18 months after implementing a comprehensive electronic health record, challenges remain regarding cumbersome documentation processes and promoting interdisciplinary communication. Thus, the results demonstrate a gap between preimplementation expectations and the postimplementation reality of the actual experience. Nonetheless, some subjects have experienced positive benefits after implementation of the comprehensive electronic health record and remain hopeful for the future.

RN Perceptions of a Newly Adopted Electronic Health Record

“…It has been previously reported that nurses were uncertain, though hopeful, about EHR benefits prior to implementation. 19 Our study revealed a similar finding, as the nurses reported optimism both before and after implementation. Laramee et al 19 reported ongoing concerns after implementation of an EHR, including challenges with documentation and interdisciplinary communication.…”

What to expect from electronic patient record system implementation: lessons learned from published evidence

“…The main challenges are around the documentation processes and difficulties in interdisciplinary communication67; face-to-face communication between nurses and doctors may be significantly reduced post-EPR implementation 68. It is therefore important that senior nurses are involved early to reduce these effects and encourage uptake 69…”

Nurses' computer literacy and attitudes towards the use of computers in health care

“…Shoham and Gonen, Brumini et al ., Simpson and Kenrick, McNeil et al . and Laramee et al . reported that nurses' computer‐related attitudes were generally positive.…”

“…[1][2][3] Several studies in the international literature have analysed nurses' computer literacy, their attitudes towards computer use and the determinants of these attitudes. 4,5,[10][11][12][13][14][15][16][17][18][19][20] Shoham and Gonen, 5 Brumini et al, 18 Simpson and Kenrick, 20 McNeil et al 21 and Laramee et al 22 reported that nurses' computer-related attitudes were generally positive. On the other hand, Campbell and McDowell 23 reported that the nurses in their study had little to no experience with nearly half of the items in the Gassert/McDowell Computer Literacy Survey.…”