Registered Nurses' Use of Electronic Health Records: Findings From a National Survey

Catherine DesRoches, DrPH; Karen Donelan, ScD; Peter Buerhaus, RN, ScD; Li Zhonghe, MS


Medscape J Med. 2008;10(7):164 

In This Article


Health information technology, and specifically electronic health records (EHRs), has the potential to improve healthcare by making patient health information more accessible at the point of care, reducing medical errors, assuring that guidelines and standards are applied in the care of patients with acute and chronic conditions, and in measuring and reducing health disparities.[1,2,3] However, some have argued that EHRs have the potential to increase errors.[4] Providers may make mistakes as they are learning to use the technology, automated processes may lead to provider inattention, and poor implementation processes can lead to confusion and fewer caregivers at patients' bedsides. Further, the implementation of this technology may increase the amount of time that providers spend in documentation.[2]

Understanding the diffusion of EHRs requires accurate and precise measurement of how and where they are being used. Recent studies have attempted to estimate the rate of adoption of EHRs in the ambulatory setting. The most recent estimate suggests that approximately 24% of physicians use either partially or fully electronic medical records.[5] More precise estimates based on the use of specific components of an EHR estimate a much lower number (approximately 9%).[6] In the hospital, adoption rates are less well-understood. The most recent data reported by the American Hospital Association indicate that 11% of hospitals have fully implemented an HER, with an additional 57% reporting partial implementation.[7] To date, very little is known about registered nurses (RNs) use of EHRs in either setting.

RNs are responsible for a significant portion of the healthcare provided in this country and are well-qualified to report on the care provided in the institutions in which they work. They make up the largest group of healthcare providers, with responsibilities ranging from providing direct patient care to managing and coordinating care processes and communications. Given the size of the RN workforce -- there were 2.3 million RNs in the US in 2006 -- their inclusion in EHR adoption efforts will affect the likelihood that these efforts will be successful.[8]

There have been several studies of RNs' perceptions and preferences regarding the use of EHRs. They generally find that RNs accept this new technology[9] and believe it will have a positive effect on the quality and safety of patient care.[10,11] However, these studies were limited in scope, focusing on EHR adoption and use in single-institution settings. Little is known about RNs' use of this technology nationwide.

Using data from a national survey of RNs, this study provides information on RNs' use of EHRs across different healthcare settings. It seeks to understand the relationship between EHR use and RNs' beliefs about the quality of nursing care provided. Specifically, the paper asks the following questions: What proportion of the RN workforce is using an EHR? Is an EHR system related to RN beliefs about quality of care and quality improvement (QI) activities? Is an EHR system associated with less time spent on paperwork and documentation and more time spent in direct patient care?


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