JMIR Publications

ABSTRACT

Background:

Nursing Homes (NH) are increasingly implementing Electronic Health Records (EHRs); however, little information is available on EHR use in NH settings. It remains unclear how care workers perceive its safety, quality and efficiency and whether EHR use might ease the burden of documentation, thereby reducing implicit rationing of it.

Objective:

(1) To describe nurses’ perceptions regarding the EHR system’s usefulness and whether sufficient numbers of computers are available in Swiss NHs; and (2) to explore the system’s association with implicit rationing of nursing care documentation.

Methods:

This is a multi-center cross-sectional study using survey data from the Swiss Nursing Homes Human Resources Project 2018 (SHURP 2018). It includes a convenience sample of 107 NHs, 302 care units and 1975 care workers, i.e., registered nurses and licensed practical nurses, from Switzerland’s German- and French-speaking regions. Care workers completed questionnaires assessing the level of implicit rationing of nursing care documentation, their perceptions of the EHR system’s usefulness and of how sufficient the number of available computers was, staffing and resource adequacy, leadership ability and teamwork and safety climate. For analysis we applied Generalized Linear Mixed Models, including individual-level nurse survey data and data on unit and facility characteristics.

Results:

Overall, the care workers perceived the EHR systems as useful: ratings ranged from 69% (“guarantees safe care and treatment”) to 78% (“allows quick access to relevant information on the residents“). However, a minority (48%) reported sufficient computers on their unit to allow timely documentation. Half responded that they sometimes or often had to ration documentation of care. After adjusting for work environment factors and safety and teamwork climate, both higher care worker ratings of the EHR system’s usefulness (β -0.12 [95%-CI: -0.17 - -0.06]) and sufficient numbers of computers (β -0.09 [95%-CI: -0.12 - -0.06]) were consistently associated with lower implicit rationing of nursing care documentation.

Conclusions:

Both the EHR system’s usefulness and the number of computers available were important explanatory factors for care workers leaving care activities, e.g., developing or updating nursing care plans, unfinished. NH managers should carefully select and implement their IT infrastructure with greater engagement and attention to the needs of their care workers. Further research is needed on developing and implementing user-friendly IT infrastructure in NHs and to evaluate their impact on care processes, as well as resident and care worker outcomes.