Nurses’ Experiences After Implementation of an Organization-Wide Electronic Medical Record: Qualitative Descriptive Study

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.

Impacts of technology implementation on nurses' work motivation, engagement, satisfaction and well‐being: A realist review

“…There were no contradictory or conflicting programme theories in the included articles to support dismissal of initial programme theories one and four. These initial programme theories were developed based on evidence from previous work and were therefore retained in their original form (Jagosh, 2020; Jedwab et al, 2019; Jedwab, Hutchinson, et al, 2021; Jedwab, Manias, et al, 2022; Wong et al, 2013). Assessment of causal inferences derived from included articles was heuristically operationalised by the research team by examining articles for causal inferences related to findings reported by the authors and discussing the applicability and relevance of findings and causality reported in articles (Jagosh, 2020).…”

“…Eight initial theories (programme theories; Appendix 1) generated from a scoping review (Jedwab et al, 2019) and findings of a large qualitative study (Jedwab, Hutchinson, et al, 2021; Jedwab, Manias, et al, 2022) were used as the basis to explore, examine and synthesise literature from a range of sources (Rycroft‐Malone et al, 2012). These initial programme theories informed the review data collection, analysis and synthesis process and were revised as the review progressed (Jagosh, 2020; Jedwab, Redley, et al, 2021).…”

“…A realist review may be conducted to develop an initial theory about how a programme or innovation may function or to test one or multiple initial theory(ies), known as a programme theory(ies) (Pawson et al, 2005). For this realist review, initial programme theories were generated from a scoping review (Jedwab et al, 2019), and findings of a large qualitative study (Jedwab, Hutchinson, et al, 2021; Jedwab, Manias, et al, 2022) were used as the basis to explore, examine and synthesise literature from a range of sources (Rycroft‐Malone et al, 2012).…”

Experience of Health Care Professionals Using Digital Tools in the Hospital: Qualitative Systematic Review

“…More than half (10/17,59%) of the studies reported on CDS tools, with 29% (5/17) of the studies investigating conventional CDS [ 62 , 63 , 66 , 67 , 71 ] and 29% (5/17) of the studies focusing on AI-based CDS [ 59 , 61 , 65 , 69 , 70 ]. Of the 17 studies, 6 (35%) focused on EHRs [ 58 , 60 , 64 , 68 , 73 , 74 ], whereas the remaining 1 (6%) study examined a remote patient-monitoring tool [ 72 ]. Of the 17 studies, 13 (76%) were solely based on qualitative individual semistructured interviews.…”

“…Of the remaining 4 studies, 2 (50%) adopted a combination of qualitative techniques, consisting of individual semistructured interviews, focus group interviews, field notes, and direct observation. Of the 17 studies, the other 2 (12%) followed a mixed methods approach [ 61 , 64 ]. They conducted qualitative individual semistructured interviews and enriched their data with quantitative surveys using the 5-point Likert scale [ 66 , 74 ].…”