Hospital work environment impacts how nurses perceive EHRs

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Data gathered from more than 12,000 nurses at 353 hospitals in four states reveal that those working in less favorable healthcare environments are dissatisfied with their electronic health record systems.

Penn Nursing’s Center for Health Outcomes & Policy Research (CHOPR) assessed nurse satisfaction with EHR systems and the concurrent effects of EHR adoption level and the hospital work environment on usability and quality outcomes.

What CHOPR found was that 25 percent of nurses reported dissatisfaction with their current EHRs while similarly high percentages reported usability issues. In addition, more than half of the nurses reported that EHRs interfered with patient care, while nearly one-third indicated that the systems did not help them to do their work efficiently.

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The first-of-its-kind study, published in the journal Applied Clinical Informatics, was supported by the Agency for Healthcare Research and Quality and the National Institute of Nursing Research.

Among the findings of the study were that differences in usability reports were vastly different by the quality of the work environment. According to the survey, almost 40 percent of nurses working in hospitals with poor work environments indicated dissatisfaction with the EHR, compared with less than 20 percent of nurses working in hospitals with better environments.

Further, almost half of nurses working in poor environments said that the system did not help them to work efficiently, vs. one-quarter of nurses surveyed in better environments.

“Our study indicated that hospital work environment plays a significant role in how nurses evaluate EHR usability and whether EHRs have their intended effects on improving quality and safety of care,” says Ann Kutney-Lee, lead investigator and adjunct associate professor of nursing, as well as a senior fellow at both CHOPR and the Leonard Davis Institute of Health Economics.

“Our data showed that the effect of EHR adoption level on outcomes was moderated and sometimes rendered insignificant after including the work environment,” added Kutney-Lee. “This moderation suggests that the work environment may play a more important role in the delivery of safe patient care than the type of EHR system.”

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