Experiences with electronic health records: Early adopters in long-term care facilities

Background: Electronic health records (EHRs) are becoming a required technology across the health care sector. Long-term care (LTC) facilities have lagged other settings in adopting health information technologies but represent an area where significant care coordination benefits might be realized. Nevertheless, managers face many of the same challenges implementing EHRs that exist in other environments when implementing enterprise-wide systems. Purposes: This study was conducted to provide a description of the early users' experiences with EHRs in LTC facilities. Methodology: Semistructured interviews were conducted. The 10 sites were all the "freestanding" LTC facilities using an EHR as of July 2008 in Texas. The interview respondents included administrators, nursing managers, nurses, certified nurse aides, and other system users. Semistructured interviews across multiple stakeholders were used to assess constructs critical to EHR adoption and implementation. Findings: The LTC facility employees who work with EHR systems on a daily basis were positive about their experiences. In particular, operational improvements were achieved through increased access to resident information, cost avoidance, increased documentation accuracy, and implementation of evidence-based practices. Practice Implications: Overall, administrators believed that the systems improved care quality and employee satisfaction and were cost effective and that the EHR made a positive return on investment. Electronic documentation led to both increases in charge capture related to resource utilization group documentation, significant savings in pharmacy waste, and reductions in nursing overtime as medical record management became more automated. Quality improvement came from computer-aided monitoring of the certified nurse aide's attendance to residents' activities of daily living

An exploratory study of the implementation of electronic health records: a two country comparison

The adoption of electronic health records has been significantly slower in Australia than many European countries. This paper compares the implementation process in Australia with Slovenia, looking at the benefits, drawbacks and success factors of e-health implementation. The authors use case studies collected in each country to discuss issues around e-health implementation. Though Slovenia has progressed much further down the road of e-health the commonality of the experiences between both cases was striking

Understanding women's, caregivers', and providers' experiences with home-based records : A systematic review of qualitative studies

Abstract: Mothers, caregivers, and healthcare providers in 163 countries have used paper and electronic home-based records (HBRs) to facilitate primary care visit. These standardized records have the potential to empower women, improve the quality of care for mothers and children and reduce health inequities. This review examines experiences of women, caregivers and providers with home-based records for maternal and child health and seeks to explore the feasibility, acceptability, affordability and equity of these interventions. We systematically searched MEDLINE, MEDLINE In-Process, MEDLINE Ahead of Print, Embase, CINAHL, ERIC, and PsycINFO for articles that were published between January 1992 and December 2017. We used the CASP checklist to assess study quality, a framework analysis to support synthesis, and GRADE-CERQual to assess the confidence in the key findings. Of 7,904 citations, 19 studies met our inclusion criteria. In these studies, mothers, caregivers and children shared HBR experiences in relation to maternal and child health which facilitated the monitoring of immunisations and child growth and development..

Patient participation in electronic nursing documentation:an interview study among community nurses

Background Patient participation in nursing documentation has several benefits like including patients' personal wishes in tailor-made care plans and facilitating shared decision-making. However, the rise of electronic health records may not automatically lead to greater patient participation in nursing documentation. This study aims to gain insight into community nurses' experiences regarding patient participation in electronic nursing documentation, and to explore the challenges nurses face and the strategies they use for dealing with challenges regarding patient participation in electronic nursing documentation. Methods A qualitative descriptive design was used, based on the principles of reflexive thematic analysis. Nineteen community nurses working in home care and using electronic health records were recruited using purposive sampling. Interviews guided by an interview guide were conducted face-to-face or by phone in 2019. The interviews were inductively analysed in an iterative process of data collection-data analysis-more data collection until data saturation was achieved. The steps of thematic analysis were followed, namely familiarization with data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and reporting. Results Community nurses believed patient participation in nursing documentation has to be tailored to each patient. Actual participation depended on the phase of the nursing process that was being documented and was facilitated by patients' trust in the accuracy of the documentation. Nurses came across challenges in three domains: those related to electronic health records (i.e. technical problems), to work (e.g. time pressure) and to the patients (e.g. the medical condition). Because of these challenges, nurses frequently did the documentation outside the patient's home. Nurses still tried to achieve patient participation by verbally discussing patients' views on the nursing care provided and then documenting those views at a later moment. Conclusions Although community nurses consider patient participation in electronic nursing documentation important, they perceive various challenges relating to electronic health records, work and the patients to realize patient participation. In dealing with these challenges, nurses often fall back on verbal communication about the documentation. These insights can help nurses and policy makers improve electronic health records and develop efficient strategies for improving patient participation in electronic nursing documentation

An organisational study into the impact of mobile devices on clinician and patient experience in Auckland, New Zealand

Mobile technology has potential to improve workflow, patient safety and quality of care, and has been identified as an important enabler of community services. However, little is known about the impact of mobile device use on clinician and patient experiences. Eleven community allied health clinicians were provided with live access to electronic health records, their email and electronic calendar, peer reviewed education and therapy mobile applications via a mobile device. Three data measures were collected over 19-weeks. First, quantitative time and motion data was gathered at baseline and follow-up to enable longitudinal analysis of clinician workflow. Second, a questionnaire consisting of rateable statements, multi-choice and open questions was completed at baseline and follow-up to enable analysis of clinician experience. Third, a short questionnaire was completed with a convenience sample of 101 patients who experienced mobile device use in their home. Clinicians and patients reported positive experiences associated with access to electronic health information at the point of care and the use of pictures, diagrams and videos to support clinical interactions. There was a significant reduction in time spent on patient related administration (

"Who's actually gonna read this?" An evaluation of staff experiences of the value of information contained in written care plans in supporting care in three different dementia care settings

BACKGROUND: Reports of increased healthcare bureaucracy and concerns over care plan quality have emerged from research and surveys into staff and service user experiences. Little is known of mental health staff perspectives on the value of written care plans in supporting dementia care. AIM: To investigate the experiences and views of staff in relation to care planning in dementia services in one National Health Service (NHS) provider Trust in England. METHOD: Grounded Theory methodology was used. A purposive sample of 11 multidisciplinary staff were interviewed across three sites in one NHS Trust. Interviews were transcribed, coded and analysed using the constant comparative method. FINDINGS: Five themes were identified and are explored in detail below: 1) Repetition; 2) the impact of electronic records on practice; 3) ambivalence about the value of paperwork; 4) time conflicts; and 5) alternative sources of information to plan care. DISCUSSION: Participants perceived that written care plans did not help staff with good practice in planning care or to support dementia care generally. Staff were frustrated by repetitive documentation, inflexible electronic records and conflicting demands on their time. IMPLICATIONS FOR PRACTICE: Frontline staff should be involved in designing new information systems including care plans. This article is protected by copyright. All rights reserved

The Implementation of Electronic Health Records: A Two Country Comparison

The adoption of electronic health records has been significantly slower in Australia than many European countries. This paper compares the implementation process in Australia with Slovenia, looking at the benefits, drawbacks and success factors of ehealth implementation. The authors use case studies collected in each country to discuss issues around ehealth implementation. Though Slovenia has progressed much further down the road of ehealth the commonality of the experiences between both cases was striking

Academic Electronic Health Record Implementation Proposal

In today’s complex and evolving healthcare system it is crucial for nurses to proficiently comprehend electronic health records (EHR) in the provision of quality, safe patient care. Electronic health records have become a federal mandate for patient funding securement in many settings. Studies suggest that implementation of an academic electronic health record (AHER) augments student learning for assuming the nurse role in key areas such as: data analysis, assessing patient care needs, administering medications safely, documenting effectively and professionally, and learning how to maintain a therapeutic nurse-client relationship with effective communication in the presence of technology (Jansen, 2014; Herbert & Connors, 2016). Additionally, evidence shows that the implementation of AEHR in a simulation enhances the realism and depth of learning for students as it better mirrors the clinical setting while facilitating faculty assessment of student skills (Meyer, Sternberger& Toscos, 2011). Even though research demonstrates ample benefits to the implementation of an AEHR in nursing education, the Nursing Department at Fort Hays State University (FHSU) utilizes paper patient charts in practice scenarios and in simulation experiences. This researcher recommends the implementation of an AEHR at FHSU to promote aptitude of the EHR, giving more time to direct patient care at time of clinicals

Designing a Patient-Centered Clinical Workflow to Assess Cyberbully Experiences of Youths in the U.S. Healthcare System

Cyberbullying or online harassment is often defined as when someone repeatedly and intentionally harasses, mistreats, or makes fun of others aiming to scare, anger or shame them using electronic devices [296]. Youths experiencing cyberbullying report higher levels of anxiety and depression, mental distress, suicide thoughts, and substance abuse than their non-bullied peers [360, 605, 261, 354]. Even though bullying is associated with significant health problems, to date, very little youth anti-bullying efforts are initiated and directed in clinical settings. There is presently no standardized procedure or workflow across health systems for systematically assessing cyberbullying or other equally dangerous online activities among vulnerable groups like children or adolescents [599]. Therefore, I developed a series of research projects to link digital indicators of cyberbullying or online harassment to clinical practices by advocating design considerations for a patient-centered clinical assessment and workflow that addresses patients’ needs and expectations to ensure quality care. Through this dissertation, I aim to answer these high-level research questions:RQ1. How does the presence of severe online harassment on online platforms contribute to negative experiences and risky behaviors within vulnerable populations? RQ2. How efficient is the current mechanism of screening these risky online negative experiences and behaviors, specifically related to cyberbully, within at-risk populations like adolescent in clinical settings? RQ3. How might evidence of activities and negative harassing experiences on online platforms best be integrated into electronic health records during clinical treatment? I first explore how harassment is presented within different social media platforms from diverse contexts and cultural norms (study 1,2, and 3); next, by analyzing actual patient data, I address current limitations in the screening process in clinical settings that fail to efficiently address core aspect of cyberbullying and their consequences within adolescent patients (study 4 and 5); finally, connecting all my findings, I recommend specific design guidelines for a refined screening tool and structured processes for implementation and integration of the screened data into patients’ electronic health records (EHRs) for better patient assessment and treatment outcomes around cyberbully within adolescent patients (study 6)