Perioperative Nurses' Attitudes Toward the Electronic Health Record
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Trinity University Digital Commons @ Trinity Health Care Administration Faculty Research Health Care Administration 2-2015 Perioperative Nurses’ Attitudes Toward the Electronic Health Record Laura S. Yontz Jennifer L. Zinn Edward J. Schumacher Trinity University, [email protected] Follow this and additional works at: https://digitalcommons.trinity.edu/hca_faculty Part of the Medicine and Health Sciences Commons Repository Citation Yontz, L.S., Zinn, J.L., & Schumacher, E.J. (2015). Perioperative nurses’ attitudes toward the electronic health record. Journal of PeriAnesthesia Nursing, 30(1), 23-32. doi: 10.1016/j.jopan.2014.01.007 This Article is brought to you for free and open access by the Health Care Administration at Digital Commons @ Trinity. It has been accepted for inclusion in Health Care Administration Faculty Research by an authorized administrator of Digital Commons @ Trinity. For more information, please contact [email protected]. Perioperative Nurses’ Attitudes Toward the Electronic Health Record Laura S. Yontz, MSN, RN, MPH, CPAN, Jennifer L. Zinn, MSN, RN, CNS-BC, CNOR, Edward J. Schumacher, PhD Background: The adoption of an electronic health record (EHR) is mandated under current health care legislation reform. The EHR pro- vides data that are patient centered and improves patient safety. There are limited data; however, regarding the attitudes of perioperative nurses toward the use of the EHR. Purpose: The purpose of this project was to identify perioperative nurses’ attitudes toward the use of the EHR. Design: Quantitative descriptive survey was used to determine attitudes toward the electronic health record. Methods: Perioperative nurses in a southeastern health system completed an online survey to determine their attitudes toward the EHR in providing patient care. Findings: Overall, respondents felt the EHR was beneficial, did not add to the workload, improved documentation, and would not eliminate any nursing jobs. Conclusions: Nursing acceptance and the utilization of the EHR are neces- sary for the successful integration of an EHR and to support the goal of patient-centered care. Identification of attitudes and potential barriers of perioperative nurses in using the EHR will improve patient safety, commu- nication, reduce costs, and empower those who implement an EHR. Keywords: perioperative, attitudes, electronic health record, electronic medical record, research. Ó 2015 by American Society of PeriAnesthesia Nurses HEALTH CARE REFORM IS A TOP PRIORITY In 2004, President George Bush said in his State in the United States, and the adoption of a of the Union Address ‘‘.by computerizing health standardized electronic health record (EHR) is a records, we can avoid dangerous medical major reform component and cost saving tool.1,2 mistakes, reduce costs, and improve care’’.3 Presi- dent Bush then established the Office of the Na- tional Coordinator for Health Information Laura S. Yontz, MSN, RN, MPH, CPAN, is an Assistant Direc- tor of Nursing for the Post Anesthesia Care Unit, Moses H. Technology (HIT). This office was charged to Cone Memorial Hospital, Greensboro, NC; Jennifer L. Fencl, develop standards and certification for electronic DNP, RN, CNS-BC, CNOR, is the Clinical Nurse Specialist for charting systems. In addition to the president’s the Operative Service Department, Cone Health, Greensboro, initiative, the Agency for Healthcare Research NC; and Edward J. Schumacher, PhD, is a Professor and Chair, and Quality launched its National Resource Center Department of Economics and Health Care Administration Trinity University, One Trinity Place, San Antonio, TX 78212. for HIT. And in 2007, the National Health Informa- Conflicts of interest: None to report. tion Network was formed and funded, providing Address correspondence to Laura S. Yontz, Moses H. Cone much momentum and attention on HIT from the Memorial Hospital, 1200 North Elm Street, Greensboro, NC federal government.3 27401; e-mail address: [email protected]. Ó 2015 by American Society of PeriAnesthesia Nurses 1089-9472/$36.00 The agency for Healthcare Research and Quality’s http://dx.doi.org/10.1016/j.jopan.2014.01.007 HIT initiative is part of the nation’s strategy to Journal of PeriAnesthesia Nursing, Vol 30, No 1 (February), 2015: pp 23-32 23 24 YONTZ, ZINN, AND SCHUMACHER put information technology to work in health available, portable, and searchable. Computer- care.4 By developing secure and private electronic accessible records have the potential to save the health records for all Americans and making health cost-strangled American medical system billions information available electronically when and of dollars in waste, repetition, and error.6 Elec- where it is needed, HIT can improve the quality tronic systems also safely bridge one of the more of care, even as it makes health care more cost- perilous chasms in medicine: the transfer of care effective.4 To achieve these advances in HIT, these when patients move from one department to agencies have intensely focused their initiatives on another and when they leave the hospital and three goals potentially seek treatment from another health care providers.6 Improve health care decision making Support patient-centered care Use of the EHR in the perioperative setting offers Improve the quality and safety of medication tremendous advantages to the perioperative team management4 through the creation of accessibility of all patients’ This early political momentum has crossed politi- information in one location. Additionally, for many cal differences and enjoyed continued support patients, the perioperative arena is the initial entry and funding, transforming the paper chart into point into the health care system, either through an electronic health record across our nation in scheduled or unscheduled surgery. Correct and many health care organizations.1 efficient use of the EHR can improve communica- tion throughout the system and help create a safer The Patient Protection and Affordable Care Act, and more efficient patient-centered experience. signed on March 23, 2010, is dedicated to providing affordable and quality health care to all Additional advantages of EHR use in the perioper- Americans. The law also places additional focus ative setting include clear communication of infor- on the growing recognition of health information mation to other departments and effectively technology as essential to health care reform.3 As capturing workload.1 Patient care is enhanced a component of this law, 19 billion dollars has and improved when information can be easily ac- been earmarked to aid the adoption of HIT and cessed. In addition, there is less repetition of pa- EHRs. The intent of these incentives is to assist tient information gathered and included in health care providers in purchasing and imple- documentation.7 These advantages aid in the pro- menting electronic systems. The act also clearly vision of safe handoffs, leading to safe patient stipulates penalties for both hospitals and physi- care and improved communication throughout cian providers who fail to adopt an electronic re- the health care system. These advantages also cord in a meaningful way.3 address the perilous chasm involving the transfer of care that takes place every day as patients In this highly technological age, computer skills move in and out of the operative areas. are no longer a nice addition to one’s resume; they are an essential skill set needed to safely and Literature Review efficiently care for patients.1 Computers play an in- tegral part in recording and disseminating informa- There is an abundance of literature describing tion in the 21st century. Communication and nurses’ attitudes and barriers in using the EHR in information management are key elements in medical and/or surgical and critical care units. health care organizations as it relates to the quality The literature reflects that documentation and re- of care provided. The quality of care that HIT en- view of the electronic record provide nursing staff ables can be directly related to the quality of infor- with increased knowledge of the patient’s current mation available to health care professionals.5 health status and has demonstrated a positive effect on the nurse’s care of the patient. This positive ef- Use of the EHR can improve the quality of informa- fect on patient care is illustrated with improved pa- tion available to the medical team caring for a pa- tient and family involvement in care, efficiency of tient in any institution. Electronic health records care, access to information impacting patient achieve this by transforming confusing and physi- safety, improved communication, and independent cally unwieldy masses of data to be instantly decision making by the nurse.8,9 Electronic health ATTITUDES TOWARD THE ELECTRONIC HEALTH RECORD 25 records also allow the clinician to focus on patient prior computer experience, team player, outlook, care; therefore, less time and energy are spent and time management skills); and (3) organization chasing paper information.1 Medical and/or surgi- (available support, training, and time). Successfully cal and critical care nurses who use the EHR consis- managing barriers can facilitate the transition to us- tently reported fewer poor patient safety and ing a computerized documentation system. In addi- quality outcomes than in hospitals without an tion, training, support, and information sharing can EHR.2 Nurses working with electronic records be critical to successful implementation.18 were less likely to report that ‘‘things fell through the cracks’’ with regards to hand-offs of patient With all the literature exploring the experience of care and transferring patients between units.2 In medical and/or surgical nurses and critical care addition, nurses felt the use of the electronic re- nurses in their use of the EHR, a gap in knowledge cord better prepared their patients for discharge.2 related to perioperative nurses was identified. Although advantages of EHR use in perioperative The literature also describes attitudes and barriers settings include organized information in tabs, to using EHR for various medical and/or surgical easy accessibility, provision of optimal care, and nurses.