1. School of Healthcare
FACULTY OF MEDICINE AND HEALTH
The Effect f th I l
Th Eff t of the Implementation of
t ti f
an Electronic Health Record on
Nursing-Sensitive Patient Outcomes
Dawn Dowding
Professor of Applied Health Research

2. Study Objectives
• To examine the impact of the introduction of an
Electronic Health Record (EHR) on nursing sensitive
( ) g
patient outcomes
• To explore how nurses use an EHR to inform
decisions about patient care

3. Overview of Methods
Interrupted Time Series Analysis
• O t
Outcome data taken from Collaborative Alliance f N i O t
d t t k f C ll b ti Alli for Nursing Outcomes
database and national quality, resource and risk management department
for Kaiser Permanente.
• Falls, Hospital Acquired Pressure Ulcers, Blood Stream Infection, Surgical
Site Infection, Ventilator Associated Pneumonia – from 2003 to 2009
• Impact of EHR on outcome and p
p process measures
Case sites
• 2 sites (medical/surgical units from 2 hospital facilities) selected for
( g p )
variation in time since EHR implemented
• Observation of nurses using EHR during a shift (n=14)
• I t i
Interviews with nurses and managers ( 26)
ith d (n=26)

4. Overview of Findings
Interrupted Time Series:
• Considerable variation between hospital facilities
• Some evidence that the implementation of EHR has an effect on HAPU
rates, independently of the effect of time
• No apparent effect of implementation of EHR on fall rates
• Analysis of data from individual facilities indicates variable impact of
implementation of EHR
i l i f
Case Site Study:
3 th
themes f
from th d t
the data
• The value of information
• Efficiency, Quality, Safety
• Impact on patients

5. Summary
Differences between facilities
• Apparent from both sets of data
p
• Variation in how EHR used at individual nurse and hospital
facility level
• Some evidence has a positive effect on outcomes
• Nurses felt positive benefits of EHR outweigh negative
aspects
• Nurses felt that they were safer
• None of the nurses interviewed said they would want to return
to
t a paper based system
b d t

6. What can we learn?
Using an integrated EHR in acute hospital facilities that has a specific nursing
g g p p g
component has the potential to:
• Improve outcomes
• I
Increase nurse efficiency
ffi i
• Improve safety of medication administration
Nurses recognize the potential benefits of using an EHR system as a way of
improving the safety of the care they provide
There is variability in the ability of nurses to use such systems effectively in
their practice
Need to involve nurses in the design of HIT systems, to ensure they are used
effectively

7. The Wider Benefits

8. The Wider Benefits