EMR 'one size does not fit all': Nurses' and midwives' opinions about using electronic medical records

Abstract

Objective: To describe the impact that electronic medical record (EMR) documentation has on nurses’ and midwives’ practice.

Background: Although both advantages and disadvantages of a digitised health system have been documented, nurses and midwives continue to express concerns about the effect EMRs and computers have on their practice and patient relationships.

Study design and methods: A cross-sectional survey design was used. An anonymous questionnaire was distributed in electronic and paper formats to identify nurses’ and midwives’ opinions of the impact of EMRs and computers on their practice and patient relationships in a regional tertiary-level hospital. Quantitative data was analysed descriptively; free-text responses were analysed thematically.

Results: Nurses (n=31) and midwives (n=49) responded. Both respondent groups disagreed that the EMR had improved teamwork with other health professionals. Overwhelmingly, midwives disagreed that EMRs had improved the quality of care (n=43, 87.8%). Nurses agreed EMRs had improved documentation standards (n=24, 77.4%) and patient safety (n=22, 71%). However, midwives responded that EMRs had not improved women’s safety (n=31, 63%). Three themes emerged from the data: computers affect my productivity; computers affect my relationship with the patient/woman; the EMR increases my frustration and stress levels. Nurses and midwives felt the heavy documentation load and lack of integration across the EMR platform reduced efficiency, discouraged teamwork, and further excluded patients/women from participating in their care.

Discussion: Although nurses and midwives agreed that the accessibility of EMRs to all health care staff is advantageous, the documentation demands of each clinical area are vastly different. The hybrid system of paper and electronic documentation increases documentation workload. Generally, midwives were more critical of the impact of EMRs on their practice.

Conclusion: Nurses and midwives identified current challenges of EMRs with respect to productivity, relationships with patients and colleagues, and user wellbeing aligning with results of other published studies. As primary users of EMRs, nurses and midwives can offer valuable feedback to health services to help deliver digitised healthcare that is user-friendly, and patient/woman centred.

Implications for research, policy, and practice: Organisations need to enact policies and procedures that facilitate nurses and midwives identifying areas of potential improvement to increase the usability and operability of the EMR. Such processes should lessen the negative impacts of EMR (such as documentation burden) on nursing/midwifery practice, with the aim of enhancing clinical and safety outcomes. It is suggested that ethnographic research studies be undertaken to gain a deeper understanding of the EMRs on nurse/midwife productivity, wellbeing, job satisfaction and patient safety concerns.

What is already known about the topic:

• Positive and negative EMR outcomes for patients and clinicians have been documented.


• Involving clinicians (especially nurses and midwives) in the development of digital systems prior to implementation has been shown to reduce negative attitudes towards them.


• Ongoing user analysis is recommended in human-centred design to improve usability and user wellbeing.

What this paper adds:

• Description of the differing experiences and challenges faced by nurses and midwives using the EMR program and computers in the same hospital.


• Positive and negative effects of the current EMR program and computers have been identified.


• This paper verifies the results of other national studies about the effects of EMRs and computers on nurses’ and midwives’ productivity, relationships, and wellbeing.