Electronic Health Record Use, Work Environments, and Patient Outcomes

When implementing electronic health records (EHRs), healthcare systems have failed to consider the organizational structures into which they have been implemented. Organizational characteristics, such as managerial support, organizational climate, and staffing resources are key to successful implementation of new technologies. Yet there has been limited research regarding the impact of EHR implementation on the work environment, particularly that of nurses, the largest group of care providers and EHR users in hospitals.

The overall purpose of this research was to investigate the relationships between EHR adoption and usability, work environment factors, and patient outcomes, as well as the effects of EHR adoption and usability on nurse outcomes, including burnout, job dissatisfaction, and intention to leave. The study aimed to determine not only whether EHR adoption and usability were related to outcomes, but also to better understand the organizational conditions under which EHRs function best in hospitals.

The specific aims of this research were as follows:

1. Examine EHR adoption and nurse reports of usability and quality of care on the role of work environment. 
2. Examine EHR adoption level and usability and the effects on patient and nurse outcomes. 
3. Examine the effects of changes in EHR adoption levels on changes in patient outcomes over time. 

The researchers conducted a mixed methods study to examine the associations between EHR adoption, usability, work environments, and outcomes. They found that EHR usability may be more important to patient outcomes and clinician wellbeing than the level of EHR adoption. Although the results suggested that use of comprehensive EHR systems may be beneficial to quality of care, burnout may be higher in hospitals with these more sophisticated systems. Their findings also revealed a strong relationship between the work environment and EHR usability, suggesting that hospitals with better work environments may be involving nurses in the selection and implementation of EHR systems. As such, involving nurses in the development, selection, and modification of EHR systems should be a priority for EHR vendors and hospital administrators. Failing to do this may have significant negative implications for nurses’ health, workforce turnover and related costs, and patient outcomes. Future research on EHR effectiveness should incorporate measures of EHR usability in order to obtain a more complete understanding of how these systems affect clinicians’ daily work and patient outcomes.