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


The survey asked about the routine use of 7 EHR components.

As shown in Table 2 , the use of these EHR components varied by provider. A substantial proportion of RNs reported that these components were not in routine use in the hospital or practice where they were employed. This ranged from 49% reporting that neither RNs nor physicians routinely used electronic decision support to 15% reporting that electronic access to test results was not in routine use in their organization. Generally, if an EHR component was reported as being in routine use, RNs reported that it was used by both physicians and RNs, with the exception of patient support materials. Here, RNs were more likely to report that this component was only in routine use among RNs and not among both RNs and physicians. This is likely to be a reflection of RNs' greater overall role in patient education.

As shown in Table 2 , RNs reported that all EHR components were routinely used only by RNs with greater frequency than they reported that these same components were routinely used only by physicians. The difference between RN and physician use was the largest for the use of electronic patient support materials (34% for RNs and 2% for physicians) and electronic ordering of tests, procedures, or drugs (30% for RNs and 5% for physicians), suggesting a greater use of these specific components by RNs.

Approximately 17% of RNs reported that a minimally functional EHR was in routine use in their organization. As discussed above, a minimally functional EHR is one that includes (1) electronic patient demographics, (2) electronic ordering of tests, procedures, or drugs, (3) electronic clinical patient notes, (4) electronic access to test results, and (5) electronic decision support. An additional 67% reported that between 1 and 4 of the components of a minimally functional EHR were in routine use, and 7% reported that no components were in routine use in their organization. The use of these technologies varied by work setting. As shown in the Figure, RNs employed in inpatient settings were significantly more likely than those in an outpatient setting to report the use of between 1 to 4 components of the minimally functional EHR and significantly less likely to report that 0 components were in routine use. The use of all 5 components of the minimally functional EHR did not vary by work setting.

Routine use of EHR components. EHR components: Electronic medical information about patients including problem list, key patient demographics; electronic ordering of tests, procedures, or drugs; electronic clinical and patient notes; electronic access to test results; electronic decision support including clinical guidelines and pathways, knowledge sources, reminders, and alerts.
Source: Vanderbilt/MGH/ICR survey of Registered Nurses, 2006

Most RNs rated the overall nursing care provided in their hospital as excellent or very good, and approximately 39% reported an improvement in the quality of nursing care provided over the past 2 years. These percentages did not vary by EHR status. However, RNs employed in hospitals or organizations with minimally functional EHRs (5 components in routine use) were significantly more likely than other RNs to report nursing excellence and QI efforts in their workplace. As shown in Table 3, RNs reporting the routine use of a minimally functional EHR were significantly more likely to be employed at a magnet designated hospital or a hospital in the process of obtaining magnet status, or at a hospital with a formal nursing shared governance program.

Table 3 illustrates the trend in QI efforts: RNs reporting the routine use of a minimally functional EHR were most likely to report QI activities and those with zero components were the least likely. These efforts included formal QI program (73% in organizations with a minimally functional EHR vs. 48% in organizations with 0 components of an EHR), increased efforts to recognize and reward nurses for excellence (69% vs. 52%), and encouragement of teamwork between RNs and physicians (61% vs. 50%).

One of the primary concerns about the adoption of EHRs is that the implementation process may increase the amount of time providers spend in documentation, thereby reducing the time spent on other patient care-related activities. Our findings suggest that at this time, the adoption of a minimally functional EHR does not significantly affect how RNs allocate their time during a typical workday. The survey asked RNs to estimate the percentage of their time spent on various tasks during a typical work week.

As shown in Table 4 , the percentage of time spent on patient-related notes and documentation did not differ significantly between RNs working in organizations with 0 EHR components and those working in organizations where a minimally functional EHR (5 EHR components) is in routine use, regardless of work setting. The difference shown on Table 4 among ambulatory care RNs only approaches significance (P < .06). Across the 3 EHR component groupings within each of the work settings, RNs did not differ significantly on the percentage of time spent on direct patient care, patient-related phone calls, QI activities, or shift change or patient hand-off functions.


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