JMIR Publications

ABSTRACT

Background:

Reports about impacts of electronic medical record (EMR) systems on clinicians are mixed. As yet, nurses’ experiences of adopting a large-scale, multi-site EMR system have not been investigated. Nurses are the largest healthcare workforce, therefore the impacts of EMR implementation must be investigated and understood to ensure patient care quality, changes to nurses’ work, and nurses themselves are not negatively impacted.

Objective:

The purpose of this study was to explore Australian nurses’ post-implementation experiences of an organization-wide EMR system.

Methods:

This qualitative descriptive study used focus group and individual interviews, and open-ended survey questions to collect data between 12- and 18-months post-implementation of an EMR across six hospital sites of a large healthcare organization in Victoria, Australia. Data were collected between November 2020 and June 2021, coinciding with the SARS-CoV-2 pandemic. Analysis comprised complementary inductive and deductive approaches. Specifically, reflexive thematic analysis was followed by framework analysis by coding of data as a barrier or facilitator to nurses’ use of the EMR using the Theoretical Domains Framework (TDF).

Results:

Overall, 158 nurses participated in the study. The EMR implementation dramatically changed nurses’ work and how they viewed their profession, and nurses were still adapting to the EMR implementation 18-months post-implementation. Reflexive thematic analysis led to the development of two themes: 1. An unintentional divide, captured nurses’ feelings of division related to how using the EMR has affected nurses, patient care and the broader nursing profession. 2. This time, it’s personal detailed nurses’ beliefs about EMR implementation leading to bigger changes to nurses as individuals and nursing as a profession compared to other changes nurses have experienced within the healthcare organization. Most frequent barriers to EMR use by nurses related to the TDF domains of environmental context and resources. Facilitators of EMR use most often related to memory, attention and decision processes. Most barriers and facilitators related to motivation.

Conclusions:

EMR implementation was perceived by nurses to have mixed impacts on provision of quality patient care and on their colleagues. Implementing technology into a healthcare setting was perceived as a complex endeavor that impacted on nurses’ perceptions of their autonomy, ways of working and professional roles. Potential negative consequences related to nursing workforce retention and patient care delivery. Motivation was the main behavioral driver for nurses’ adoption of EMR systems and hence a key consideration for implementing interventions or organizational changes directed at nurses.