Adoption and Barriers to Adoption of Electronic Health Records by Nurses in Three Governmental Hospitals in Eastern Province, Saudi Arabia

摘要

Although electronic health records (EHRs) have been implemented in many hospitals and healthcare providers benefit from their effective and efficient data processing, their evaluation from nurses has received little attention. This project aimed to assess the adoption and barriers to the use of an EHR system by nurses at three governmental hospitals implementing the same EHR software and functionalities in Eastern Province, Saudi Arabia. The study was a cross-sectional, paper-based questionnaire study. SPSS version 20 was used for data entry and analysis, and descriptive statistics were calculated. The study found underutilization of almost all functionalities among all hospitals and no utilization of any communication tools with patients. In addition, there were no instances of “allowing patients to use the Internet to access parts of their health records.” The most frequently cited barrier among all hospitals was “loss of access to medical records transiently if computer crashes or power fails” (88.6 percent). This was followed by “lack of continuous training/ support from information technology staff in hospital” (85.9 percent), “additional time required for data entry” (84.9 percent), and “system hanging up problem” (83.8 percent). Complexity of technology (81.6 percent) and lack of system customizability (81.1 percent) were also frequently reported problems. The formation of an EHR committee to discuss problems with the system in Saudi hospitals is recommended. Keywords: EHR, use, barriers, nurses, Saudi ArabiaIntroductionHealth information technology benefits both patients and providers with respect to healthcare quality.~(~(1)) Health information technology is defined as “the application of information processing involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decision making.”~(~(2)) Adapting to technological innovations represents a key process for improving and restructuring healthcare.~(~(3), ~(4), ~(5), ~(6)) Electronic health records (EHRs) have been touted as an essential component in the transformation of the healthcare industry.~(~(7)) Technological developments have exposed nursing personnel to new tasks and responsibilities in many areas of practice.~(~(8), ~(9), ~(10), ~(11)) Nurses are the largest segment of the healthcare workforce in the acute care setting; thus, nurses' advocacy of the EHR is a key factor influencing its adoption.~(~(12))Adoption of EHRs continues to progress rapidly within the healthcare industry. This new technology reshapes healthcare at all levels of the industry, especially nursing.~(~(13)) Since this technology first became popular, nursing professionals have used computer systems in patient care.~(~(14), ~(15), ~(16), ~(17)) Both medical secretaries and nurses are important users of hospital information systems, utilizing both the EHR and the administrative part of the system. The medical secretaries work as transcriptionists, receptionists, and coordinators of patient logistics and communication, and the nurses have their own documentation and administrative routines.~(~(18)) Nurses interact most with EHR systems as a result of the nature of their work. They make nursing diagnoses,~(~(19)) check physician orders,~(~(20)) write nursing care plans,~(~(21)) record vital signs, and sometimes transcribe physician orders,~(~(22)) among other roles.Although EHRs have been implemented in many hospitals and healthcare providers benefit from their effective and efficient data processing, the evaluation of EHRs by nurses who provide 24-hour patient care~(~(23)) has received little attention.~(~(24), ~(25)) It has been acknowledged in recent years that technology and therefore computerization will contribute to the decision-making capabilities and skills of nurses, improve the quality of healthcare, reduce the costs of services,~(~(26), ~(27)) and improve the safety of care.~(~(28), ~(29))However, EHR systems have yet to be widely adopted for several reasons,~(~(30), ~(31)) including the high cost of implementation, users' resistance to technology, concerns regarding practice disruption and loss of productivity, fear of technology failure, and the inability of some EHR implementations to integrate with existing healthcare systems.~(~(32), ~(33), ~(34)) Furthermore, unintended adverse consequences can surround the implementation and ongoing maintenance of these systems.~(~(35), ~(36), ~(37)) Recently, new kinds of medical errors have occurred, have negatively affected patient outcomes, and have resulted in higher overall medical costs for institutions implementing some EHR systems.~(~(38), ~(39), ~(40)) Thus, ongoing analysis of EHRs is needed to understand barriers experienced by users and to help find solutions.Gap of KnowledgeOne study found that nursing assessments and the work associated with EHR implementation increases the demand for nurses'