Difference between revisions of "Review Of Nurse Experiences With Electronic Health Records"

Revision as of 06:47, 23 April 2016

The article A Systematic Review of Nurses’ Experiences With Unintended Consequences When Using the Electronic Health Record by Sheila Gephart, Jane M. Carrington, and Brooke Finley, discusses the potential dangers of implementing a new EHR, or changing an existing one, from the perspective of the nurses who use the system daily.

Abstract

While EHR adoption has tripled in 2015 compared to 2009, there is research that demonstrates adoption can result in unintended consequences for nurses. Little is known about experiences with unintended consequences from EHR implementation from the nursing perspective, and few studies have been conducted to investigate this. Through a review of 4 original studies, it was found that while nurses experience workflow changes, difficulty accessing important patient information, and must continually adapt to meet patients needs with imperfect EHR systems, they would prefer to stick with the paperless EHR system. To work around these issues, nurse administrators need to perform continual engagement with nurses throughout EHR design, and encourage them to speak up when changes made by the EHR would lead to harm to the patient.

Background

Studies of physician interactions with EHRs show that the following perceptions and reception of the system occur among the EHR users:

  1.	Added work
  2.	Persistence of paper system use
  3.	Threats to communication
  4.	Heightened emotions
  5.	Emergence of unpredicted errors
  6.	Alteration in power structure
  7.	Overdependence on technology

There were also found to be eight types of unintended consequences, barriers to efficient use of the EHR, with poor EHR implementation:

  1.	More or new work
  2.	Alteration of workflow
  3.	Imposition of new demands on the system
  4.	Altered communication
  5.	Strong emotions
  6.	New kinds of health care errors
  7.	Shifting power across disciplines
  8.	Overdependence on technology

Of the eight unintended consequences, workflow changes and alterations to communication were the most concerning among clinicians. Wrong patient identification and juxtaposition errors were identified consequences as a result of poor EHR implementation, alongside the main eight consequences mentioned. Safety concerns, including "technovigilance" and delayed treatment, were identified through the studies of EHR implementation as well.

A review of 45 clinical scenarios revealed instances of misrepresentation or underrepresentation of data; these threaten the understanding of patient needs, as a result of inconsistencies, endangering the patient. Five types of misrepresentations were identified:

  1.	EHR data too narrowly focused
  2.	EHR data too broadly focused
  3.	Display of data that miss critical information
  4.	Contradictory, redundant, or confusing data
  5.	Data distortions reflected both by user and sensors

Methods

Queries were run through CINAHL and PubMed, including full text entries, using the terms "barrier and work-around to electronic health record", "unintended consequences", and "nurs*" to include nursing, nurse, and similar terms. The search for relevant studies on nurse interactions with the EHR yielded 130 articles. Most were discarded for lack of relevance to the subject being searched for, and editorial and review papers were also discarded. After thinning out the search, five (5) articles were found to be relevant and were reviewed.

Results

Discussion

Conclusion

Comments

References

1. Gephart S, Carrington JM, Finley B. A Systematic Review of Nurses' Experiences With Unintended Consequences When Using the Electronic Health Record. Nurs Adm Q. 2015 Oct-Dec. 39(4):345-56.

Submitted by Nathan Gerstmann