In an attempt to study the sociotechnical factors that can shape the relationship between electronic health record adoption and quality of care, researchers at the University of Pennsylvania School of Nursing found that nurses’ satisfaction with the EHR shows a correlation with their assessment of the hospital work environment.
Penn Nursing’s Center for Health Outcomes & Policy Research (CHOPR) examined survey data on nurse satisfaction with EHR systems and the concurrent effects of EHR adoption level and the hospital work environment on usability and quality outcomes. Data from more than 12,000 nurses at 353 hospitals in four states show that nurses in hospitals with better environments are less likely than nurses in less favorable environments to report dissatisfaction with EHR systems.
The study, "Electronic Health Record Adoption and Nurse Reports of Usability and Quality of Care: The Role of Work Environment," has been published in the journal Applied Clinical Informatics.
Nearly 40 percent of nurses working in hospitals with poor work environments reported dissatisfaction with the EHR system compared with less than 20 percent of nurses working in hospitals with better environments. Nearly half of nurses working in poor environments reported that the EHR system did not help them to work efficiently, compared with one-quarter of nurses in better environments.
Overall, 25 percent of nurses reported dissatisfaction with their current record systems, while similarly high percentages reported usability issues. Over half of the surveyed nurses reported that EHRs interfered with patient care, while nearly one-third reported that the EHRs did not help them to do their work efficiently.
"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 lead investigator Ann Kutney-Lee, Ph.D., R.N., adjunct associate professor of nursing and a senior fellow at both CHOPR and the Leonard Davis Institute of Health Economics, in a prepared statement. “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."
