Evaluation of a Mobile Station Electronic Health Record on Documentation Compliance and Nurses’ Attitudes
Author(s)
Mei-Wen Wu1,
Ting-Ting Lee2*,
Tzu-Chuan Tsai1,
Chin-Yi Huang1,
Francis Fu-Sheng Wu3,
Mary Etta Mills4
Affiliation(s)
1 Changhua Christian Hospital, Changhua City, Taiwan. 2 National Taipei University of Nursing and Health Sciences, Taipei, Taiwan. 3 University of Otago, Wellington, New Zealand. 4 University of Maryland, Baltimore, USA.
1 Changhua Christian Hospital, Changhua City, Taiwan. 2 National Taipei University of Nursing and Health Sciences, Taipei, Taiwan. 3 University of Otago, Wellington, New Zealand. 4 University of Maryland, Baltimore, USA.
ABSTRACT
Electronic Health Record (EHR) Systems have been adopted by healthcare organizations for documentation of patient care. Often these information systems are embedded in mobile nurse stations. As part of assessing the impact of this technology it is important to determine the effect it has on charting compliance and user acceptance. Data were collected at a medical center in Taiwan in two stages. The first stage involved use of a 28-item medical review tool to measure charting compliance in 99 charts before and after implementation of the EHR system. In stage two, a survey was conducted with 709 nurse users to determine their level of mobile EHR acceptance 3 months after this documentation technology was initiated. Results demonstrated that EHR significantly improved documentation compliance in standardized data entry format (name, date, time), abbreviation, content correction/revision, patient care needs, and care goals. Analysis of data from the five categories of a user acceptance survey revealed the following results (based on a 4-point Likert scale): patient care (2.92), nursing efficiency (2.78), education and training (2.98), usability (2.61), and usage benefits (2.87). The study concluded that use of mobile nurse stations with EHR can improve documentation compliance and that although frequent system downtime needs improvement, nurses generally have positive attitudes toward this technology application.
Electronic Health Record (EHR) Systems have been adopted by healthcare organizations for documentation of patient care. Often these information systems are embedded in mobile nurse stations. As part of assessing the impact of this technology it is important to determine the effect it has on charting compliance and user acceptance. Data were collected at a medical center in Taiwan in two stages. The first stage involved use of a 28-item medical review tool to measure charting compliance in 99 charts before and after implementation of the EHR system. In stage two, a survey was conducted with 709 nurse users to determine their level of mobile EHR acceptance 3 months after this documentation technology was initiated. Results demonstrated that EHR significantly improved documentation compliance in standardized data entry format (name, date, time), abbreviation, content correction/revision, patient care needs, and care goals. Analysis of data from the five categories of a user acceptance survey revealed the following results (based on a 4-point Likert scale): patient care (2.92), nursing efficiency (2.78), education and training (2.98), usability (2.61), and usage benefits (2.87). The study concluded that use of mobile nurse stations with EHR can improve documentation compliance and that although frequent system downtime needs improvement, nurses generally have positive attitudes toward this technology application.
KEYWORDS
Documentation Compliance, Information System, Mobile Nursing Station, Nurse Attitudes, Technology
Documentation Compliance, Information System, Mobile Nursing Station, Nurse Attitudes, Technology
Cite this paper
Wu, M. , Lee, T. , Tsai, T. , Huang, C. , Fu-Sheng Wu, F. and Mills, M. (2015) Evaluation of a Mobile Station Electronic Health Record on Documentation Compliance and Nurses’ Attitudes. Open Journal of Nursing, 5, 678-688. doi: 10.4236/ojn.2015.57071.
Wu, M. , Lee, T. , Tsai, T. , Huang, C. , Fu-Sheng Wu, F. and Mills, M. (2015) Evaluation of a Mobile Station Electronic Health Record on Documentation Compliance and Nurses’ Attitudes. Open Journal of Nursing, 5, 678-688. doi: 10.4236/ojn.2015.57071.
References
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http://dx.doi.org/10.1016/j.ijmedinf.2007.09.001 [2] Mahler, C., Ammenwerth, E., Wagner, A., Tautz, A., Happek, T., Hoppe, B. and Eichstädter, R. (2007) Effects of a Computer-Based Nursing Documentation System on the Quality of Nursing Documentation. Journal of Medical System, 31, 274-282.
http://dx.doi.org/10.1007/s10916-007-9065-0 [3] Thordoddsen, A., Ehnfors, M. and Ehrenberg, A. (2011) Content and Completeness of Care Plans after Implementation of Standardized Nursing Terminologies and Computerized Records. Computers, Informatics, Nursing, 29, 599-607.
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http://dx.doi.org/10.1097/NXN.0b013e318270100b [8] Wu, M.W., Lee, T.T., Tsai, T.C., Lin, K.C., Huang, C.Y. and Mills, M.E. (2013) Evaluation of a Mobile Shift Report System on Nursing Documentation Quality. Computers, Informatics, Nursing, 31, 85-93.
http://dx.doi.org/10.1097/NXN.0b013e318266cac3 [9] Lee, T.T., Mills, M.E. and Lu, M.H. (2009) The Multimethod Evaluation of a Nursing Information System in Taiwan. Computers, Informatics, Nursing, 27, 245-253.
http://dx.doi.org/10.1097/NCN.0b013e3181a91b90 [10] Lee, T.T. (2008) Nursing Information: Users’ Experiences of a System in Taiwan One Year after Its Implementation. Journal of Clinical Nursing, 17, 763-771.
http://dx.doi.org/10.1111/j.1365-2702.2007.02041.x [11] Urquhart, C., Currell, R., Grant, M.J. and Hardiker, N.R. (2009) Nursing Record Systems: Effects on Nursing Practice and Healthcare Outcomes. Cochrane Database of Systematic Reviews, No. 1, Article No. CD002099.
http://dx.doi.org/10.1002/14651858.cd002099.pub2 [12] McDowell, D.E., Dillon, T.W. and Lending, D. (2008) Perceived Quality Benefits Influenced by Usefulness and Documentation Accuracy of Information Systems. Computers, Informatics, Nursing, 26, 350-357.
http://dx.doi.org/10.1097/01.NCN.0000336463.72069.7c [13] Bennett, K.J. and Steen, C. (2010) Electronic Medical Record Customization and the Impact Upon Chart Completion Rates. Family Medicine, 42, 338-342. [14] American Nurses Association (2008) Nursing Informatics: Scope and Standards of Practice. NursesBooks, Silver Spring. [15] Blumenthal, D. and Tavenner, M. (2010) The “Meaningful Use” Regulation for Electronic Health Records. New England Journal of Medicine, 363, 501-504.
http://dx.doi.org/10.1056/NEJMp1006114 [16] Centers for Medicare & Medicaid Services (2010) EHR Incentive Programs.
http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html [17] Gunningberg, L., Dahm, M.F. and Ehrenberg, A. (2008) Accuracy in the Recording of Pressure Ulcers and Prevention After Implementing an Electronic Health Record in Hospital Care. Quality & Safety in Health Care, 17, 281-285.
http://dx.doi.org/10.1056/NEJMp1006114 [18] Simpson, R.L. (2005) Patient and Nurse Safety: How Information Technology Makes A Difference. Nursing Administration Quarterly, 29, 97-101.
http://dx.doi.org/10.1097/00006216-200501000-00015 [19] Kuo, Y.H., Lee, T.T., Mills, M.E. and Lin, K.C. (2012) The Evaluation of A Web-Based Incident Reporting System. Computers, Informatics, Nursing, 30, 386-394.
http://dx.doi.org/10.1097/NXN.0b013e31825106ea [20] Huang, H.Y. and Lee, T.T. (2011) Impact of Bar-Code Medication Administration on Nursing Activity Patterns and Usage Experience in Taiwan. Computers, Informatics, Nursing, 29, 554-563.
http://dx.doi.org/10.1097/NCN.0b013e31820662c1 [21] Yui, B.H., Jim, W.T., Chen, M., Hsu, J.M., Liu, C.Y. and Lee, T.T. (2012) Evaluation of Computerized Physician Order Entry System—A Satisfaction Survey in Taiwan. Journal of Medical System, 36, 3817-3824.
http://dx.doi.org/10.1007/s10916-012-9854-y [22] Gruber, D., Cummings, G.G., LeBlanc, L. and Smith, D.L. (2009) Factors Influencing Outcomes of Clinical Information Systems Implementation: A Systematic Review. Computers, Informatics, Nursing, 27, 151-163.
http://dx.doi.org/10.1097/NCN.0b013e31819f7c07 [23] Yee, T., Needleman, J., Pearson, M., Parkerton, P., Parkerton, M. and Wolstein, J. (2012) The Influence of Integrated Electronic Medical Records and Computerized Nursing Notes on Nurses’ Time Spent in Documentation. Computers, Informatics, Nursing, 30, 287-292.
http://dx.doi.org/10.1097/nxn.0b013e31824af835 [24] Kurashima, S., Kobayashi, K., Toyabe, S. and Akazawa, K. (2008) Accuracy and Efficiency of Computer-Aided Nursing Diagnosis. International Journal of Nursing Terminologies & Classifications, 19, 95-101.
http://dx.doi.org/10.1111/j.1744-618X.2008.00088.x [25] Lee, T.T. (2007) Nurses’ Experiences Using a Nursing Information System: Early Stage of Technology Implementation. Computers, Informatics, Nursing, 25, 294-300.
http://dx.doi.org/10.1097/01.NCN.0000289166.61863.0b [26] Husting, P.M. and Cintron, L. (2003) Healthcare Information Systems: Education Lessons Learned. Journal for Nurses in Staff Development, 19, 253-257.
http://dx.doi.org/10.1097/00124645-200309000-00008 [27] Brooks, C.L. and Erickson, L.K. (2012) What Is the Solution for Clinical Nurse Educators and the Electronic Medical Record? Teaching and Learning in Nursing, 7, 129-132.
http://dx.doi.org/10.1016/j.teln.2012.06.003 [28] Allan, N., Bell, D. and Pittard, A. (2011) Resuscitation of the Written Word: Meeting the Standard for Cardiac Arrest Documentation. Clinical Medicine, 11, 348-352.
http://dx.doi.org/10.7861/clinmedicine.11-4-348
[1] Häyrinen, K., Saranto, K. and Nykänen, P. (2008) Definition, Structure, Content, Use and Impacts of Electronic Health Records: A Review of the Research Literature. International Journal of Medical Informatics, 77, 291-304.
http://dx.doi.org/10.1016/j.ijmedinf.2007.09.001 [2] Mahler, C., Ammenwerth, E., Wagner, A., Tautz, A., Happek, T., Hoppe, B. and Eichstädter, R. (2007) Effects of a Computer-Based Nursing Documentation System on the Quality of Nursing Documentation. Journal of Medical System, 31, 274-282.
http://dx.doi.org/10.1007/s10916-007-9065-0 [3] Thordoddsen, A., Ehnfors, M. and Ehrenberg, A. (2011) Content and Completeness of Care Plans after Implementation of Standardized Nursing Terminologies and Computerized Records. Computers, Informatics, Nursing, 29, 599-607.
http://dx.doi.org/10.1097/NCN.0b013e3182148c31 [4] Nielsen, G., Peschel, L. and Burgess, A. (2014) Essential Documentation Elements: Quality Tool for the Emergency Department Nurse. Advanced Emergency Nursing Journal, 36, 199-205.
http://dx.doi.org/10.1097/TME.0000000000000020 [5] Alexander, S., Frith, K.H., O’Keefe, L. and Hennigan, M.A. (2011) Implementation of Customized Health Information Technology in Diabetes Self Management Programs. Clinical Nurse Specialist, 25, 63-70.
http://dx.doi.org/10.1097/NUR.0b013e31820aefd6 [6] Smith, D., Morris, A. and Janke, J. (2011) Nursing Satisfaction and Attitudes with Computerized Software Implementation: A Quasi-Experimental Dtudy. Computes, Informatics, Nursing, 29, 245-250.
http://dx.doi.org/10.1097/NCN.0b013e3181f9dcfa [7] Hsu, S.C., Liu, C.F., Weng, R.H. and Chen, C. J. (2013) Factors Influencing Nurses’ Intentions toward the Use of Mobile Electronic Medical Records. Computers, Informatics, Nursing, 31, 124-132.
http://dx.doi.org/10.1097/NXN.0b013e318270100b [8] Wu, M.W., Lee, T.T., Tsai, T.C., Lin, K.C., Huang, C.Y. and Mills, M.E. (2013) Evaluation of a Mobile Shift Report System on Nursing Documentation Quality. Computers, Informatics, Nursing, 31, 85-93.
http://dx.doi.org/10.1097/NXN.0b013e318266cac3 [9] Lee, T.T., Mills, M.E. and Lu, M.H. (2009) The Multimethod Evaluation of a Nursing Information System in Taiwan. Computers, Informatics, Nursing, 27, 245-253.
http://dx.doi.org/10.1097/NCN.0b013e3181a91b90 [10] Lee, T.T. (2008) Nursing Information: Users’ Experiences of a System in Taiwan One Year after Its Implementation. Journal of Clinical Nursing, 17, 763-771.
http://dx.doi.org/10.1111/j.1365-2702.2007.02041.x [11] Urquhart, C., Currell, R., Grant, M.J. and Hardiker, N.R. (2009) Nursing Record Systems: Effects on Nursing Practice and Healthcare Outcomes. Cochrane Database of Systematic Reviews, No. 1, Article No. CD002099.
http://dx.doi.org/10.1002/14651858.cd002099.pub2 [12] McDowell, D.E., Dillon, T.W. and Lending, D. (2008) Perceived Quality Benefits Influenced by Usefulness and Documentation Accuracy of Information Systems. Computers, Informatics, Nursing, 26, 350-357.
http://dx.doi.org/10.1097/01.NCN.0000336463.72069.7c [13] Bennett, K.J. and Steen, C. (2010) Electronic Medical Record Customization and the Impact Upon Chart Completion Rates. Family Medicine, 42, 338-342. [14] American Nurses Association (2008) Nursing Informatics: Scope and Standards of Practice. NursesBooks, Silver Spring. [15] Blumenthal, D. and Tavenner, M. (2010) The “Meaningful Use” Regulation for Electronic Health Records. New England Journal of Medicine, 363, 501-504.
http://dx.doi.org/10.1056/NEJMp1006114 [16] Centers for Medicare & Medicaid Services (2010) EHR Incentive Programs.
http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html [17] Gunningberg, L., Dahm, M.F. and Ehrenberg, A. (2008) Accuracy in the Recording of Pressure Ulcers and Prevention After Implementing an Electronic Health Record in Hospital Care. Quality & Safety in Health Care, 17, 281-285.
http://dx.doi.org/10.1056/NEJMp1006114 [18] Simpson, R.L. (2005) Patient and Nurse Safety: How Information Technology Makes A Difference. Nursing Administration Quarterly, 29, 97-101.
http://dx.doi.org/10.1097/00006216-200501000-00015 [19] Kuo, Y.H., Lee, T.T., Mills, M.E. and Lin, K.C. (2012) The Evaluation of A Web-Based Incident Reporting System. Computers, Informatics, Nursing, 30, 386-394.
http://dx.doi.org/10.1097/NXN.0b013e31825106ea [20] Huang, H.Y. and Lee, T.T. (2011) Impact of Bar-Code Medication Administration on Nursing Activity Patterns and Usage Experience in Taiwan. Computers, Informatics, Nursing, 29, 554-563.
http://dx.doi.org/10.1097/NCN.0b013e31820662c1 [21] Yui, B.H., Jim, W.T., Chen, M., Hsu, J.M., Liu, C.Y. and Lee, T.T. (2012) Evaluation of Computerized Physician Order Entry System—A Satisfaction Survey in Taiwan. Journal of Medical System, 36, 3817-3824.
http://dx.doi.org/10.1007/s10916-012-9854-y [22] Gruber, D., Cummings, G.G., LeBlanc, L. and Smith, D.L. (2009) Factors Influencing Outcomes of Clinical Information Systems Implementation: A Systematic Review. Computers, Informatics, Nursing, 27, 151-163.
http://dx.doi.org/10.1097/NCN.0b013e31819f7c07 [23] Yee, T., Needleman, J., Pearson, M., Parkerton, P., Parkerton, M. and Wolstein, J. (2012) The Influence of Integrated Electronic Medical Records and Computerized Nursing Notes on Nurses’ Time Spent in Documentation. Computers, Informatics, Nursing, 30, 287-292.
http://dx.doi.org/10.1097/nxn.0b013e31824af835 [24] Kurashima, S., Kobayashi, K., Toyabe, S. and Akazawa, K. (2008) Accuracy and Efficiency of Computer-Aided Nursing Diagnosis. International Journal of Nursing Terminologies & Classifications, 19, 95-101.
http://dx.doi.org/10.1111/j.1744-618X.2008.00088.x [25] Lee, T.T. (2007) Nurses’ Experiences Using a Nursing Information System: Early Stage of Technology Implementation. Computers, Informatics, Nursing, 25, 294-300.
http://dx.doi.org/10.1097/01.NCN.0000289166.61863.0b [26] Husting, P.M. and Cintron, L. (2003) Healthcare Information Systems: Education Lessons Learned. Journal for Nurses in Staff Development, 19, 253-257.
http://dx.doi.org/10.1097/00124645-200309000-00008 [27] Brooks, C.L. and Erickson, L.K. (2012) What Is the Solution for Clinical Nurse Educators and the Electronic Medical Record? Teaching and Learning in Nursing, 7, 129-132.
http://dx.doi.org/10.1016/j.teln.2012.06.003 [28] Allan, N., Bell, D. and Pittard, A. (2011) Resuscitation of the Written Word: Meeting the Standard for Cardiac Arrest Documentation. Clinical Medicine, 11, 348-352.
http://dx.doi.org/10.7861/clinmedicine.11-4-348