Impact of Heath Information Technology on Delivery and Quality of Patient Care

Theory and conceptual models propose that the adoption of electronic health records (EHRs) will have a positive and direct effect on the quality of nursing care and patient outcomes. These theories and models also support the idea that EHRs will reduce “missed” nursing care – necessary clinical activities that are not accomplished by shift's end because there isn't enough time – by enhancing communication and timely decision processes.

This study used a cross-sectional design to examine the relationships between the stage of EHR adoption, missed nursing care, and the nursing practice environment’s adverse effect on hospitalized patients’ outcomes and satisfaction. The analysis took into account patient and hospital characteristics, including measures of nurse staffing and organizational climate. The study hypothesis was that EHR implementation would be associated with more complete delivery of nursing care, lower rates of adverse patient events, and higher levels of patient satisfaction.

The specific aims of this project were to:

• Quantify the unique and cumulative effects of differing: 1) EHR implementation and functionality; 2) organizational climate; and 3) nurse staffing levels on the delivery of nursing care.
• Quantify the unique and cumulative effects of differing: 1) EHR implementation and functionality; 2) organizational climate; 3) nurse staffing levels; and 4) delivery of nursing care on patient mortality and non-mortality adverse outcomes such as catheter-related blood stream infections and hospital readmission.
• Quantify the unique and cumulative effects of differing: 1) EHR implementation and functionality; 2) organizational climate; 3) nurse staffing levels; and 4) delivery of nursing care on patient satisfaction.

Data on approximately 854,000 adult patients discharged at 70 New Jersey hospitals and approximately 7,700 nurses working in those same hospitals was analyzed. The principal significant findings were: 1) a positive relationship between nursing practice environment and patient satisfaction; and 2) inverse relationships between advanced EHR adoption and adverse outcome of prolonged length of stay; nursing practice environment and missed nursing care; and missed nursing care and patient satisfaction. Staffing and resource adequacy was the strongest predictor of missed nursing care and patient satisfaction. Further analysis showed that there is no direct effect of EHR on patient satisfaction outcomes, even when controlling for the nursing practice environment and missed nursing care.

In summary, findings from this study did not support the theoretical propositions between advanced EHR adoption stage and patient outcomes, but did support the connection between a better work environment, less missed care, and higher patient satisfaction.