JAMIA: Long-term EHR usability depends on design
Recent research published in the Journal of American Medical Informatics Association suggested that factors related to technology design have strong effects on acceptance, even one year after an EHR implementation.
“Our study showed that ICU nurses' acceptance and perceptions of EHR usability and usefulness improved over a period of one year after EHR implementation,” wrote Pascale Carayon, PhD, from the department of industrial and systems engineering at the University of Wisconsin-Madison in Madison, and colleagues.
EHR usability and the usefulness of computerized provider order entry (CPOE) were consistent predictors of EHR acceptance both in the short term (three months post-EHR implementation) and the long term (12 months post), Carayon and colleagues stated.
To assess ICU nurses’ acceptance of EHR technology and examine the relationship between EHR design, implementation factors and acceptance, the researchers analyzed data from two cross-sectional survey questionnaires distributed to nurses working in four ICUs at a northeastern U.S. regional medical center at three months and 12 months following an EHR implementation.
On average, ICU nurses were more accepting of the EHR at 12 months as compared to three months, the researchers found. “Although the data do not permit longitudinal analyses to be performed, the results suggest that these average improvements in acceptance, usability, and usefulness may be related to the ‘learning curve’ effect,” the authors wrote. “That is, over time (from 3 to 12 months), ICU nurses become more familiar with the EHR technology and its various functionalities because of their increasing use of and exposure to the technology.”
Survey instruments were developed to measure EHR acceptance and usability, and the usefulness of three EHR functions: CPOE, electronic medication administration record (eMAR) and a nursing documentation flowsheet.
Nurses perceived the EHR as being more usable and both CPOE and eMAR as being more useful at 12 months. Multivariate hierarchical modeling indicated that EHR usability and CPOE usefulness predicted EHR acceptance at both three and 12 months. At three months post implementation, eMAR usefulness predicted EHR acceptance, but its effect disappeared at 12 months. Nursing flowsheet usefulness predicted EHR acceptance but only at 12 months.
Only about 30 percent of ICU nurses participated in at least one of 11 implementation activities, mostly in feedback teams and departmental meetings, the authors noted. “This may explain why ICU nurses were more likely to report positive opinions about information received about EHR implementation than about their inputs into decision-making related to EHR implementation.”
The authors called for more research using a longitudinal design to further understand how EHR-related predictors of technology acceptance change over time. This would help EHR implementers identify key issues that need to be addressed in the short-term versus the long-term, concluded the authors.
“Our study showed that ICU nurses' acceptance and perceptions of EHR usability and usefulness improved over a period of one year after EHR implementation,” wrote Pascale Carayon, PhD, from the department of industrial and systems engineering at the University of Wisconsin-Madison in Madison, and colleagues.
EHR usability and the usefulness of computerized provider order entry (CPOE) were consistent predictors of EHR acceptance both in the short term (three months post-EHR implementation) and the long term (12 months post), Carayon and colleagues stated.
To assess ICU nurses’ acceptance of EHR technology and examine the relationship between EHR design, implementation factors and acceptance, the researchers analyzed data from two cross-sectional survey questionnaires distributed to nurses working in four ICUs at a northeastern U.S. regional medical center at three months and 12 months following an EHR implementation.
On average, ICU nurses were more accepting of the EHR at 12 months as compared to three months, the researchers found. “Although the data do not permit longitudinal analyses to be performed, the results suggest that these average improvements in acceptance, usability, and usefulness may be related to the ‘learning curve’ effect,” the authors wrote. “That is, over time (from 3 to 12 months), ICU nurses become more familiar with the EHR technology and its various functionalities because of their increasing use of and exposure to the technology.”
Survey instruments were developed to measure EHR acceptance and usability, and the usefulness of three EHR functions: CPOE, electronic medication administration record (eMAR) and a nursing documentation flowsheet.
Nurses perceived the EHR as being more usable and both CPOE and eMAR as being more useful at 12 months. Multivariate hierarchical modeling indicated that EHR usability and CPOE usefulness predicted EHR acceptance at both three and 12 months. At three months post implementation, eMAR usefulness predicted EHR acceptance, but its effect disappeared at 12 months. Nursing flowsheet usefulness predicted EHR acceptance but only at 12 months.
Only about 30 percent of ICU nurses participated in at least one of 11 implementation activities, mostly in feedback teams and departmental meetings, the authors noted. “This may explain why ICU nurses were more likely to report positive opinions about information received about EHR implementation than about their inputs into decision-making related to EHR implementation.”
The authors called for more research using a longitudinal design to further understand how EHR-related predictors of technology acceptance change over time. This would help EHR implementers identify key issues that need to be addressed in the short-term versus the long-term, concluded the authors.