Dawn Dowding: Implementation of an electronic health record
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The document summarizes a study examining the impact of implementing an electronic health record (EHR) on nursing-sensitive patient outcomes. The study used interrupted time series analysis and case site observations and interviews. Key findings include: - There was considerable variation between hospital facilities in the effect of EHR implementation on outcomes like hospital-acquired pressure ulcers and fall rates. - Nurses felt that EHRs provided benefits like increased efficiency, quality and safety that outweighed negatives. - While EHRs have potential to improve outcomes and nurse performance, there is variability in how effectively nurses use such systems in practice. Involving nurses in EHR design could help ensure effective use.
Dawn Dowding: Implementation of an electronic health record
- 1. School of Healthcare FACULTY OF MEDICINE AND HEALTH The Effect f th I l Th Eff t of the Implementation of t ti f an Electronic Health Record on Nursing-Sensitive Patient Outcomes Dawn Dowding Professor of Applied Health Research
- 2. Study Objectives • To examine the impact of the introduction of an Electronic Health Record (EHR) on nursing sensitive ( ) g patient outcomes • To explore how nurses use an EHR to inform decisions about patient care
- 3. Overview of Methods Interrupted Time Series Analysis • O t Outcome data taken from Collaborative Alliance f N i O t d t t k f C ll b ti Alli for Nursing Outcomes database and national quality, resource and risk management department for Kaiser Permanente. • Falls, Hospital Acquired Pressure Ulcers, Blood Stream Infection, Surgical Site Infection, Ventilator Associated Pneumonia – from 2003 to 2009 • Impact of EHR on outcome and p p process measures Case sites • 2 sites (medical/surgical units from 2 hospital facilities) selected for ( g p ) variation in time since EHR implemented • Observation of nurses using EHR during a shift (n=14) • I t i Interviews with nurses and managers ( 26) ith d (n=26)
- 4. Overview of Findings Interrupted Time Series: • Considerable variation between hospital facilities • Some evidence that the implementation of EHR has an effect on HAPU rates, independently of the effect of time • No apparent effect of implementation of EHR on fall rates • Analysis of data from individual facilities indicates variable impact of implementation of EHR i l i f Case Site Study: 3 th themes f from th d t the data • The value of information • Efficiency, Quality, Safety • Impact on patients
- 5. Summary Differences between facilities • Apparent from both sets of data p • Variation in how EHR used at individual nurse and hospital facility level • Some evidence has a positive effect on outcomes • Nurses felt positive benefits of EHR outweigh negative aspects • Nurses felt that they were safer • None of the nurses interviewed said they would want to return to t a paper based system b d t
- 6. What can we learn? Using an integrated EHR in acute hospital facilities that has a specific nursing g g p p g component has the potential to: • Improve outcomes • I Increase nurse efficiency ffi i • Improve safety of medication administration Nurses recognize the potential benefits of using an EHR system as a way of improving the safety of the care they provide There is variability in the ability of nurses to use such systems effectively in their practice Need to involve nurses in the design of HIT systems, to ensure they are used effectively