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

Disclosures

Medscape J Med. 2008;10(7):164 

In This Article

Discussion

This study is the first to provide national data on RNs' use of EHRs. The findings point to 2 issues of importance to patient safety and healthcare quality. First, the use of a minimally functional EHR is associated with QI efforts in healthcare organizations, including achieving magnet status, having formal nursing shared governance, and having a formal QI program. Future research examining the association between EHR use and quantitative measures, such as length of stay, patient outcomes, and compliance with guidelines, in addition to more qualitative perceptual measures, would lead to a better understanding of the impact of EHR adoption on quality of care.

It may be that healthcare organizations that engage in QI adopt EHRs because their leaders believe that this technology will improve the quality of healthcare provided at their institution. Conversely, it may be that organizations adopt these technologies before engaging in other QI processes and that this adoption affects the likelihood that they will take further steps to improve the quality of care they provide. A cross-sectional study such as this one does not provide a definitive answer to this question; however, it does suggest a relationship between QI and EHR adoption that bears further study.

Second, when asked about barriers to adopting an EHR, providers often cite worries about an increase in time spent in documentation. This study suggests that RNs employed in organizations with a minimally functional EHR do not spend significantly more time in patient-related notes and documentation. Data on hospital and practice size could shed further light on this finding. However, better quality care may take longer to provide and organizations with well-developed QI programs and shared governance may document patient care more intensely for the purposes of quality measurement. Therefore, any efficiencies gained in the time spent in documentation could be confounded by the greater overall volume of documentation taking place at these organizations.

In this study, we assessed the routine use of a minimally functional EHR among RNs working in inpatient and ambulatory settings. The findings suggest that the use of individual functionalities varies across work settings and that fewer than 1 in 5 RNs currently work in institutions or other settings that have adopted what the Office of the National Coordinator for Health Information Technology has endorsed as a minimally functional EHR.

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