Only One in Five Nurses Use Electronic Records
By Debra Wood, RN, contributor
Only one in five registered nurses working in health care settings are routinely using electronic health records (EHR) according to a new study, which also found that facilities with computerized documentation show a higher degree of nursing excellence and quality improvement efforts.
“I consider the most important finding to be the low level of adoption of these technologies,” said lead author Catherine DesRoches, DrPH, an instructor at Massachusetts General Hospital/Harvard Medical School Institute for Health Policy in Boston. “A large majority of nurses do not have access to these technologies.”
According to a new study, computerized documentation was related to nursing excellence and increased quality improvement efforts.
The researchers mailed a survey to a nationally representative sample of registered nurses and received 1,392 useable responses. This is the first study to provide information about how nurses use electronic records.
About 17 percent of inpatient nurses reported routinely using minimally functional electronic health records, meaning the systems capture patient demographics; allow for electronic ordering of tests, procedures or drugs; and provide for clinical notes, electronic access to test results and decision support. An additional 67 percent used between one and four of the components.
In most facilities, both nurses and physicians used electronic health records, DesRoches said, but when only one discipline used them, it was the nurses.
“Often organizations will get nurses on board first, before they try to get physicians on board when they are making a change,” DesRoches said. “They work to get the RNs to champion the system.”
Registered nurses employed in hospitals or organizations with minimally functional EHRs were significantly more likely than other RNs to report nursing excellence at their facilities and quality improvement efforts.
“Places that have these systems are also more likely to be doing things [related] to nurse quality indicators,” DesRoches said. “It’s impossible to say, at this point, if the electronic record is driving this increase in quality improvement effort or if places that do quality improvement are more likely to have these records.”
DesRoches referred to it as a “chicken-and-egg” issue.
The study found facilities using electronic records are more likely to be ANCC Magnet-designated hospitals or have formal nurse shared-governance systems. Sixty percent of nurses from Magnet hospitals said they had at least some electronic functionality while 16 percent said their Magnet hospital lacked a computerized system.
Nurses often express concern that switching to an electronic record system will increase documentation, thus decreasing time available for patient care. The study found that was not an issue. The amount of time spent on patient-related notes and documentation did not differ significantly between the nurses working in organizations with no electronic record and those with all five functions in routine use.
DesRoches said that once nurses learn an electronic system and become proficient at using the templates and pull-down menus, it becomes easier and quicker to document. But even those nurses who initially spend more time at it, later embrace the system or at least find it time neutral.
“It takes a lot more time at the beginning when clinicians are learning the new systems,” DesRoches said. “It’s not the way they have done things in the past, and they have to change practice to adapt to it. But once they do it, it makes them more efficient.”
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