Full Answer Section

• haudhry, B., Wang, A., Wu, S., Maglione, M., Mojica, W., Roth, E., Morton, S. C., & Shekelle, P. G. (2006). Systematic review: Impact of health information technology on quality, efficiency, and costs of medical care. Annals of Internal Medicine, 144(10), 742–752.

  • Summary: This seminal systematic review synthesizes evidence from numerous studies to evaluate the comprehensive impact of health information technology (HIT), including EHRs, on various aspects of healthcare. The authors found consistent evidence that HIT significantly improves quality of care, particularly through enhanced adherence to guidelines, reduced medication errors, and improved disease management. They also noted evidence for improved efficiency, though cost savings were less consistently demonstrated.
  • Evaluation of Impact: This article provides strong foundational evidence for EHRs’ positive impact on both quality and safety. For patient safety, the most notable impact is the reduction in medication errors due to computerized physician order entry (CPOE) and clinical decision support (CDS) systems within EHRs. These features flag potential drug interactions, allergies, and incorrect dosages, preventing adverse drug events. In terms of quality of care, EHRs enhance adherence to clinical guidelines by providing readily accessible protocols and reminders, leading to more standardized and evidence-based care delivery. The review implies improved interdisciplinary team communication by facilitating shared patient data access, though this is less explicitly detailed than safety and quality.
  • Analysis of Evidence: The evidence presented is robust, stemming from a systematic review, which offers a high level of confidence in its findings. The focus on CPOE and CDS is particularly relevant for nursing, as nurses are often at the front lines of medication administration and require precise, real-time information to ensure patient safety. The reduction in medication errors directly translates to fewer adverse events and improved patient outcomes. The emphasis on guideline adherence supports consistent, high-quality care across the continuum.
  • Recommendation: Based on this evidence, healthcare organizations should prioritize comprehensive implementation of EHRs with fully functional CPOE and CDS systems. Nursing leadership should advocate for robust training programs focusing on leveraging these features to maximize medication safety and ensure adherence to best practices. Furthermore, regular audits of medication administration errors should be conducted to demonstrate the ongoing positive impact of EHRs.

• Kushniruk, A. W., & Patel, V. L. (2018). Cognitive and ergonomic analyses of health information technology. Journal of Biomedical Informatics, 88, 1–4.

  • Summary: This article delves into the cognitive and ergonomic factors influencing the usability and effectiveness of health information technology, including EHRs. It highlights that while EHRs offer numerous benefits, their design and implementation can inadvertently introduce new challenges, such as cognitive overload for clinicians, alert fatigue, and workflow disruptions if not optimized for human-computer interaction. The authors advocate for user-centered design principles to mitigate these issues.
  • Evaluation of Impact: This article emphasizes the critical link between EHR usability and patient safety and quality. Poorly designed EHRs can lead to errors, delays in care, and burnout among nursing staff, directly impacting safety and quality. Conversely, ergonomically sound EHRs enhance nurse workflow and efficiency, reducing cognitive load and allowing nurses more time for direct patient care, thereby improving quality. The interdisciplinary team benefits when all members find the system intuitive, facilitating seamless information exchange rather than creating barriers.
  • Analysis of Evidence: The authors’ analysis points to the importance of human factors in technology adoption. Issues like alert fatigue, where nurses become desensitized to excessive or irrelevant alerts, pose a significant safety risk. The evidence suggests that a well-designed EHR reduces the cognitive burden on nurses, allowing them to focus more on critical thinking and less on navigating a cumbersome system. This directly impacts how efficiently and safely nurses can perform their duties.
  • Recommendation: Healthcare organizations must prioritize user-centered design principles and conduct thorough usability testing of EHR systems, especially from a nursing workflow perspective. Ongoing feedback mechanisms for nurses should be established to identify and address usability issues promptly. Regular updates and customization of EHRs based on workflow analysis can significantly improve nurse satisfaction, reduce errors, and enhance overall patient safety and care quality.

• Hagland, M. (2019). The evolving role of the EHR in care coordination. Healthcare Informatics, 36(6), 18–20.

  • Summary: This article discusses the evolving role of the EHR as a central tool for care coordination, particularly in complex healthcare environments. It highlights how EHRs facilitate seamless information exchange among various healthcare providers, fostering a more integrated and patient-centered approach to care. The discussion centers on how EHRs support communication, reduce duplication of services, and improve transitions of care.