Nursing Work Environment Impacts Electronic Health Records System Adoption

Hospital work environment plays a pivotal role in how nurses evaluate electronic health records (EHRs), and whether EHRs positively impact quality and safety of care, according to a first-of-its-kind study, conducted by University of Pennsylvania Nursing’s Center for Health Outcomes & Policy Research (CHOPR), and published in Applied Clinical Informatics.

Researchers assessed the survey data of 12,377 nurses working in 353 hospitals across four states using a secondary analysis of three linked data sources, including the 2015 to 2016 RN4CAST-US nurse survey, the 2015 American Hospital Association (AHA) Annual Survey Database, and the 2015 AHA Healthcare Information Technology (IT) Database. The analysis included hospitals that had at least 10 nurse survey respondents who yielded reliable estimates of work environment and were represented in the AHA Annual Survey and IT Databases. Unadjusted and adjusted logistic regression models were used to gauge the relationship between EHR adoption level, work environment, and a set of EHR usability, quality, and safety outcomes.

EHR Efficacy Tied to Nurse Satisfaction

In fully adjusted models, the study suggests comprehensive EHR adoption was associated with lower odds of nurses reporting poor usability outcomes, such as dissatisfaction with the system (OR=0.75; 95% CI, 0.61 to 0.92). Moreover, the study indicated that work environment was associated with all usability outcomes with nurses in better environments being less likely to report negatively. Furthermore, comprehensive EHRs (OR=0.83; 95% CI, 0.71 to 0.96) and better work environments (OR=0.47; 95% CI, 0.42 to 0.52) were correlated with lower odds of nurses reporting fair to poor quality of care, while poor patient safety grade was associated with the work environment (OR=0.50; 95% CI, 0.46 to 0.54), but not EHR adoption level.

Concurrent Strategy Needed

“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,” said Ann Kutney-Lee, PhD, FAAN, Adjust Associate Professor of Nursing, and lead-investigator of the study, in a press release. “Our data showed that the effect of EHR adoption level on outcomes was moderated and sometimes rendered insignificant after including the work environment. 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.”

The researchers also wrote about the study’s implications.

“One of the leading reasons for poor outcomes following HER adoption may be the lack of consideration for how the system will interface with end-users and the existing organizational structure,” said researchers in a summation of their findings. “Adoption of a comprehensive EHR system is associated with greater satisfaction and usability ratings by nurses, as well as higher nurse-reported quality of care. The best outcome may be achieved by concurrently implementing comprehensive EHR systems and improving hospital work environments.”