Dixon, Lindsay

Electronic Health Records and Patient Safety: Nurse Practitioners’ Experiences in Clinical Practice

Whitt, Karen, College of Nursing

Introduction

The purpose of this project was to evaluate practicing nurse practitioners’ experiences and satisfaction with electronic health records (EHRs). In response to health policy initiatives and incentives, many healthcare organizations in the U.S. have recently implemented EHRs in clinical practice. Despite expectations that EHRs can improve patient safety, there is evidence that EHRs have the potential to contribute to adverse patient events and medical errors. Therefore, an urgent need to improve the safety of EHRs has been recognized.
In June 2015, a study was conducted by Dr. Karen Whitt that invited nurse practitioners to share their experiences and satisfaction with EHRs. More than 300 different EHRs are utilized by healthcare organizations and each EHR is extremely different. The aim of this descriptive study was to evaluate nurse practitioners’ experience and satisfaction with EHRs and to describe problems encounters with EHRs in clinical practice and the impact on patient safety.

Methodology

Nurse practitioners who attended the American Association of Nurse Practitioners’ (AANP) 2015 annual meeting had the opportunity to complete a survey about their experiences with EHRs. Permission to collect data for this study was obtained from AANP and from the principal investigator’s university Institutional Review Board (IRB). The participants completed a 50-item survey about EHRs. There were 4 items that assess information about EHR utilization including years of experience using an EHR, years of experience using an EHR, hours spent using an EHR per 8-hour work day, type of documentation and the brand of EHR used. The survey also included 9 statements about EHR preferences related to comfort, satisfaction, ease of finding information, productivity, and influence on patient outcomes. These statements were rated on a 5-point Likert scale including the responses; strongly agree, agree, agree somewhat, disagree, and strongly disagree. Participants were also asked an open-ended question, “Describe any problems you have experienced in the past with EHRs.”
Responses to the survey questions were analyzed using SPSS statistical software to report percentages and frequencies. Content analysis of responses to the open-ended question was conducted by 4 researchers to identify common themes among the responses. The data collected from this project was presented at multiple conferences and written into a paper that will be submitted for publication.

Results

There were 431 nurse practitioners who completed the survey. The majority of the sample was female (88.6%), with a mean age of 48 years, had completed a master’s degree (76.1%), and worked in outpatient (82.1%), family practice settings (53.0%). Almost half of the sample (47.0%) reported working in other specialty settings including home health, internal medicine, obstetrics and gynecology, cardiology, endocrinology, pediatrics, intensive care, emergency room, orthopedics, oncology, genetics, neurology, palliative care, dermatology, geriatrics,
occupational health, post anesthesia care, and pain management. The nurse practitioners had a mean of 10.5 with a range of 0-41 years of practice experience as a nurse practitioner.
The nurse practitioners’ in our sample reported using 94 different EHR products. It is interesting to note that a small percentage of the sample reported using paper charting (4.9%) and some of the sample used a combination of both paper and electronic records (6.7%). The survey participants reported a mean of 7.8 years of experience using EHRs and reported spending a mean of 6.1 hours per 8-hour workday using or searching the EHR.
The nurse practitioners rated statements regarding preferences, comfort, ease of use, satisfaction, productivity, job satisfaction, patient care, patient outcomes, and problems with EHRs. While the majority of participants indicated a preference for using EHRs, it is interesting to note that there was still some preference towards using paper records. About half of the respondents (53.4%) strongly agreed that they were comfortable using EHRs. The participants indicated that they were not entirely satisfied with their EHR and that information was not easy to find. Over half or the participants agreed or strongly agreed that EHRs contribute to adverse patient outcomes (65.5%). Additionally, about half of the participants agreed or strongly agreed that they had experienced problems in the past with EHRs (49.4%).
Content analysis of the responses to the open-ended questions, “Describe any problems you have experienced in the past with EHRs,” was conducted by four researchers and 8 main themes were identified. These 8 themes included; 1) Glitches and crashes, 2) Difficulties, 3) Too many clicks, 4) Changing relationships with Patients, 5) Medication problems, 6) Charting on auto-pilot, 7) Adverse patient events, 8) Positive thoughts.

Discussion

From this data, the researchers concluded that nurse practitioners see the benefit of EHRs and agree that electronic charting is superior to paper charting. However, nurse practitioners still experience difficulties with EHRs that negatively impact job satisfaction and productivity. Many nurse practitioners believed that EHRs are created by software engineers with little-to-no input from healthcare providers, thus making the systems counterintuitive and difficult to use in the healthcare setting. Also, numerous nurse practitioners commented that they would have desired more training on how to effectively and correctively operate their respective EHRs. Therefore, from our results we concluded that nurse practitioners would be more satisfied with their EHRs if aspects of the design and training processes were altered. This would allow nurse practitioners to feel like they could use their EHRs in the safest and most effective manner.

Conclusion

The aim of this descriptive study was to evaluate nurse practitioners’ experience and satisfaction with EHRs and to describe problems encounters with EHRs in clinical practice and the impact on patient safety. Data was collected at the American Association of Nurse Practitioners’ (AANP) 2015 annual meeting and after analysis, was written into a paper. Further, the results were presented at the BYU College of Nursing Annual Scholarly Works Conference in Provo, UT and SINI 2016 26th Summer Institute in Nursing Informatics in Baltimore, MD. Overall, researchers concluded that nurse practitioners dislike many aspects of their EHRs though they are able to see how EHRs can positively benefit the current healthcare system. The researchers think that changing aspects of the design and training processes could help nurse practitioners feel more comfortable using their EHRs and could allow the EHRs to be safer and more user-friendly. Overall, EHRs are a profitable aspect of our healthcare system; however, the data from nurse practitioners revealed that changes still need to be made to EHRs to make them easier to use and safer for patients.