See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/276114995

Nurses Readiness and Electronic Health Records

Article  in  Acta Informatica Medica · April 2015

DOI: 10.5455/aim.2015.23.105-107

CITATIONS READS

23 1,162

3 authors:

Mahdi Habibi koolaee Reza Safdari

Golestan University of Medical Sciences Tehran University of Medical Sciences
31 PUBLICATIONS   149 CITATIONS    37 PUBLICATIONS   280 CITATIONS   

SEE PROFILE SEE PROFILE

Hamid Bouraghi
Hamadan University of Medical Sciences
22 PUBLICATIONS   94 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Integrative modeling of stroke mechanism ... View project

Survey and Explanation of Information Management of Computerized Nursing Information Systems View project

All content following this page was uploaded by Mahdi Habibi koolaee on 26 July 2015.

The user has requested enhancement of the downloaded file.

 Nurses Readiness and Electronic Health Records 105
Published online: 14/04/2015 Published print:04/2015

doi: 10.5455/aim.2015.23.105-107 © 2015 Mahdi Habibi-Koolaee, Reza Safdari, Hamid Bouraghi

This is an Open Access article distributed under the terms of the Creative Commons
ACTA INFORM MED. 2015 APR 23(2): 105-107
Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/)
Received: 11 January 2015 • Accepted: 15 March 2015
which permits unrestricted non-commercial use, distribution, and reproduction in any
medium, provided the original work is properly cited.

ORIGINAL PAPER

Nurses Readiness and Electronic Health Records

Mahdi Habibi-Koolaee1, Reza Safdari1, Hamid Bouraghi2,1
Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
1

Department of Librarianship and Medical Information, Hamadan University of Medical Sciences& Health Services, Hamadan, Iran
2

Corresponding author: Hamid Bouraghi, PhD. Faculty Member of Librarianship and Medical Information Department, Hamadan University of Medical Sciences& Health
Services, Hamadan, Iran. Phone: +989122542926; Email: bouraghi@umsha.ac.ir:

ABSTRACT
Background: The importance of the electronic health records in health care well known to everybody, as well as, the role of nurses to provide clinical care;
they have a valuable role in successful implementation of electronic systems. The aim of this paper is to assess the nurses’ readiness for EHR implementa-
tion. Methods and Materials: This was a descriptive cross sectional study, conducted in 2013. Using cluster sampling, 310 nurses selected from teaching
hospitals at Tehran University of Medical Sciences (TUMS). A self-structured questionnaire was used for gathering data. Data management and analysis
was performed using SPSS for windows by using descriptive statistics. Results: 85.9% of nurses, participated in the study. The Microsoft Word (58.8%)
was the higher level of skill according to ICDL. The mean of computer skills, knowledge and attitude of nurses towards EHR was 43.4%, 51.2% and 65.2%,
respectively. In overall, the mean of readiness of nurses was 57.2%. Establish proper communication among providers and prevent duplications was the
most positive attitude and complexity of service delivery was the most negative attitude toward EHR. Conclusion: The most obvious finding to emerge
from this study is that it should be considered in the education, training and participation of nurses, it should be ensured the level of knowledge and attitude
toward EHR and finally, some related courses in Health Information Systems suggested including the curriculum of nursing.
Keywords: Electronic Health Records, Nurse, Readiness assessment, Implementation, Attitude, Knowledge, Computer skills.

1. INTRODUCTION study aimed to assess the readiness of nursing in teaching hos-

In the past decades, some activities began to use informa- pital at Tehran University of Medical Sciences.
tion systems in the healthcare domain. Its main target is to
gain Electronic Health Records (1, 2). On the other hand, 2. METHODS AND MATERIALS
changing paper-based records to electronic/ computerized re- This descriptive-cross sectional study, was conducted in
cords, the nursing practice veer towards computerized docu- 2013. Using Simple sampling from nurses of teaching hospi-
mentation of care (3). In fact, nursing managers turned to use tals at Tehran University of Medical Sciences, 284 employees
the electronic records to meet their clinical, administrative were randomly selected. The data were collected by self-
and legal informational requirements (4). Electronic health structured questionnaire. The questionnaire consisted of four
records are an important issue in the context of the health categories. The first part, deal with demographic information
sector, which includes longitudinal health care information, of employees. The second category, deal with computer skills,
stored in electronic form, to support the ongoing care, edu- based on ICDL skills that measured according to five Likert
cation and research (3, 5). Electronic health records provide type. The third part of the questionnaire included fourteen
many advantages for nurses, including medication reminders, questions and measured the knowledge level about objectives,
prevent drug interactions, immediate access to patient med- benefits and overall concept of EHR. These parts of questions
ical history and documentation of clinical care (3). have one correct answer. The latest part included twenty –
Always, there are restrictions on the use of EHR (6). In three questions and deal with attitude of participants toward
many studies, lack of user participation and readiness are EHR that measured by five options (strongly agree, agree, no
the major factor to failure of information systems, as well as consideration, disagree, strongly disagree).
lower investment of resources about user`s readiness to accept The design of this questionnaire was based on Jebraeily and
changes and implementation of EHR (7, 8). Nurses have an his colleagues (1). Concept validity was evaluated by the ex-
important role to provide clinical care, thus they have a valu- perts’ views. To assess the internal consistency of questions
able role in successful implementation of electronic systems the questionnaire was pre-tested and after the analyzing the
(3). If health care providers accept these technologies, we will data, the Cronbach α was calculated (α=0.82).
have a successful EHR. Without their acceptance and partici- Using descriptive statistics, the average scores of computer
pation, all efforts to develop of an HER would be ineffective skills, knowledge and attitude of participants were computed.
(9). The role of manpower readiness is a critical factor for the Frequency tables were used to describe ordinal data. The cor-
success implementation of EHR. The attention to this signifi- relation between computer skills, knowledge and attitude
cant matter has faded in the country (Iran), especially in the were tested using the Spearman test. A p-value of <0.05 was
Tehran province. Beside, nursing- as the focus of care- has considered statistically significant. The data were evaluated
an important effect to implement information systems. This by the Statistical Package of Social Science (SPSS) for win-

ACTA INFORM MED. 2015 APR 23(2): 105-107 / ORIGINAL PAPER

106 Nurses Readiness and Electronic Health Records

Standard De- Mean SD Percentage

Type of skill Mean Percentage
viation (SD) Computer skills 2.17 0.34 43.4
Initial Concepts 2.50 0.73 50.0 Knowledge 2.56 0.65 51.2
Windows 2.44 0.74 48.8 Attitude 3.26 0.19 65.2
Microsoft Word 2.94 0.78 58.8 overall 2.86 0.20 57.2
Microsoft Excel 2.04 0.66 40.8
Table 3. Nurses Readiness on the EHR implementation (range 1-5)
Microsoft Access 1.23 0.48 24.6
Microsoft PowerPoint 2.10 0.62 42.0 Computer skills Knowledge Attitude
Coefficient p-value Coefficient p-value Coefficient p-value
Using Email and the Internet 1.93 0.73 38.6
Total 2.17 0.34 43.4 Computer skills 0.019 0.77 -0.055 0.39
Knowledge -0.241 0.00
Table 1. Participants level of computer skills (Range 1-5) Attitude

dows. Participation was voluntary and nurses gave their con- Table 4. Spearman correlation among computer skills, knowledge and
sent to participate. In order to respect the confidentiality, the attitude of Nurses
identification information of participants was not mentioned that the highest level of skill according ICDL was Microsoft
publicly. Word (58.8 %). Most nurses had the lowest skill in Microsoft
Access skill (24.6 %). Almost, half of them used computers at
3. RESULTS home (50.2%) but only 32 % used computers at work. The use
Of the study population, 85.9% of nurses (77.5% Female, of Email and World Wide Web was 28%.
22.5% Male) completed and returned the questionnaire. The The mean score for knowledge of nurses about EHR`s uses
mean age was 32.44±7.47 and mean years of work experiences and applications was 51.2 %. A minority of nurses has a good
was 8.75±6.56. Most of the participants had a Bachelor’s de- knowledge regarding “clinical terminologies in the EHR”
gree (98.4%) and only 1.6 % had master degree and above. (19%) and “standards related to EHR” (33%). They have the
86.3 % of them had an ICDL training certificate. In analyzing highest level of knowledge regarding “main goals of EHR”
the computer skills of participants (Table 1), results showed (75%) and “types of information in the EHR” (66%).
It can be seen from the data in Table 2 that the most positive
Issues Mean SD Percentage attitude towards EHR is about “to establish proper communi-
To promote the quality of care 4.07 0.99 81.4 cation among healthcare providers” (87.2%) and “to prevent du-
To establish Proper communication among
4.36 0.75 87.2 plications” (87.2%). The most negative attitude towards EHR is
healthcare providers
To prevent medical errors using alerts and
about “to cause complexity of service delivery” (40.8%). As Table
4.11 0.96 82.2 3 shows, the overall readiness of nurses on EHR implementation
reminders
To prevent duplication 4.36 0.74 87.2 was 57.2 percent. As can be seen from the Table 4, there is no sig-
To enhance service delivery 3.79 1.10 75.8 nificant correlation between computer skills and knowledge and
To help better documentation 3.84 0.99 76.8 between computer skills and attitude, but a negative correlation
To timely access information 4.32 0.74 86.4 found between knowledge and attitude (p<0. 05).
High security & confidentiality in the EHR
2.50 0.99 50.0
regarding the paper-based records 4. DISCUSSION
Higher accuracy and precision in the EHR
3.97 0.74 79.4 In this study, the readiness of nurses in teaching hospital at
regarding the paper-based records
Lower flexibility and modify information in
Tehran University of Medical Sciences on implementation the
2.12 0.81 42.4 EHR was assessed. The readiness of nurses in this study was
the EHR regarding the paper-based records
To make the work most satisfactory and computed by computer skills, knowledge and attitude. The
3.46 1.10 69.2
simplify level of computer skill was assessed based on ICDL training.
To improve work 3.34 1.07 66.8 Amatayacul (2005) believe that to assess readiness of health-
To causes increased workload and wasting care providers for implementing EHR, their computer skills,
2.33 1.06 46.6
time
knowledge and attitude should be surveyed (10). Terry and
To improve workflow 3.74 1.00 74.8
colleagues (2008) showed that the readiness of healthcare pro-
To endanger the work position 2.30 0.77 46.0
viders is related to their computer skills and knowledge about
To disclose weakness and incompetency of
the employee
2.19 0.75 43.8 EHR. They stated that physicians, nurses and other providers
To impose discipline of work 2.19 0.75 43.8 who have high computer skills would welcome the imple-
To cause new responsibilities and much mentation of EHR (11).
2.09 0.79 41.8
expectations Hier et al. (2005) reported that using of computer by health-
To increase the need to acquire new skills 3.87 0.81 77.4 care providers was 59.5% at home and 86.75% at work and
To cause complexity of service delivery 2.04 0.69 40.8 using of Email was 88.2%(12). In the same study of Jebraeily
To impose high costs on the organization 2.06 0.71 41.2 et al. (2010) clinician’s use of computer was 55.4% at home
To eliminate and the lack of permanent and 53.6% at work and the use of Email and WWW was 59%.
backup of data due to hardware and soft- 3.82 0.78 76.4
ware problems in the EHR
In Jebraeily`s study the highest mean of computer skills by
To endanger confidentiality and security in clinicians was Microsoft Word skill(75%) and the Microsoft
4.07 0.82 81.4 Access skill was the lowest (40%)(1). The comparison of these
the EHR
Overall 3.26 0.19 65.2 studies showed that the mean ICDL skills (especially, Micro-
Table 2. Mean score of nurses’ attitude towards EHR (Range 1-5) soft Word and Access) of nurses in this study is lower than of

ORIGINAL PAPER / ACTA INFORM MED. 2015 APR 23(2): 105-107

 Nurses Readiness and Electronic Health Records 107

Hier and Jebraeily`s study. In the research of Hostgaard and 5. CONCLUSION

Nohr (2004), reported that nurses have less experience to use This study has shown that the level of computer skills of
computer (15.6%)(8), while Jebraeily et al. (2010)showed that nurses needs to enhance. The findings of the study suggest
nurses` level of computer skills was 53.4%(1). In this research, that the hospitals should conduct practical training courses on
we found that nurses` level of computer skill was 43.4%. This computer uses and applications.
level is less than of Jebraeily et al. study and higher than of As the correlation analysis between knowledge and attitude
Hostgaard and Nohr study. Given that nurses dealing with showed, the nurses who have high knowledge about EHR
computer in environments with information systems, it is have a low attitude toward it. In general, it seems that nurses
necessary to improve their skills in this area, particularly in intend workshop/conference about the role of computerized
skills such as MS Office. Regarding knowledge about EHR, systems in the field of healthcare. Strongly, it is recommended
on average, the nurse`s knowledge level was 51.2%. In Je- that a related course on health information systems / EHR
braeily et al. were 64% (1). should be included in the curriculum of nursing.
Moody (2004) in a study that surveyed nurses` perceptions, Since, the readiness of personnel is a critical factor to imple-
attitude and preference on EHR documentation stated that ment an EHR, therefore, it is essential to consider the educa-
nurses believe the EHR is a care facilitator (81%), improves tion, training and participation of nurses ensure appropriate
clinical documentation (75%), threatens information confi- knowledge and attitude about them.
dentiality (54%) and increases workload (66%). In this study Acknowledgment
nurse believes that EHR improves clinical documentation The authors would like to thank all nurses from teaching hospitals of
(76.8%), threatens information confidentiality and security TUMS for their kind participation in this study.
(81.4%) and increases workload (46.6%) (13). Richards and
colleagues (2005) showed that 95% of participants use in- CONFLICT OF INTEREST: NONE DECLARED.
ternet and Email. Nurses use E-Health less than physicians.
They showed that the most positive aspects of E-Health were REFERENCES
clinical usefulness (76%), equipment performance (74%) and 1. Jebraeily M, Ahmadi M, Hajavi A, Gohari M, Sedghi Jahromi M, Zareh
Z. Electronic Health Records: Personnel Readiness Assessment. JHA.
facilitating the use of equipment (74%). The major barriers 2010; 13(39): 17-24.
to implement E-Health was the lack of education (55%), high 2. Miller RH, Sim I. Physicians’ use of electronic medical records: barriers
costs of equipment purchase (54%), the increase of nurses and and solutions. Health Aff (Millwood). 2004 Mar-Apr; 23(2): 116-126.
physician`s workload (43%) and concerns over the informa- 3. Ahmadi M, Rafii F, Habibi Koolaee M. Nursing Information Manage-
ment. Tehran: Jafari Publications, 2011.
tion confidential (36%) (14). In the study of Jebraeily et al. 4. Ahmadi M, Rafii F, Hoseini F, Habibi Koolaee M, Mirkarimi A. Infor-
(2010) the most positive attitude towards implementing EHR mational and Structural Needs of Nursing Data Classification in Com-
was improving quality of health care services (86%) and im- puterized Systems. Hayat. 2011; 17(1): 16-23.
proving the documentation (81%) and the most negative at- 5. Ahmadi M, Rezaei H, Shahmoradi L. Electronic Health Record: Struc-
ture, Content, and Evaluation. Tehran: Jafari Publications, 2008.
titude was endangering work position (42.4%), increasing 6. Jebraeily M, Piri Z, Rahimi B, Ghasemzade N, Ghasemirad MAM. Bar-
workload and time wasting (49.8%) and endangering infor- riers of Electronic Health Records Implementation. Health Information
mation confidentiality and security (54.6%)(1). As the results Management. 2012; 8(6): 814.
showed, to concern about information confidentiality and se- 7. Clarke S. Information systems strategic management: an integrated ap-
proach. London; New York: Routledge, 2001.
curity, to increase the workload and costs was common nega- 8. Hostgaard AM, Nohr C. Dealing with organizational change when im-
tive attitude in all studies. Also, to make prevention of du- plementing EHR systems. Studies in health technology and informatics
plications and to improve quality of documentation were the 2004; 107(Pt 1): 631-634.
most positive attitude. According to findings, the majority 9. Versavel C, Anderson S, Goodine R. Infoway`s End User Strategy Can-
ada Health Infoway. 2007.
of nurses are of the opinion that EHR Complicates service 10. Amatayakul M. EHR? Assess readiness first. Healthcare financial man-
delivery therefore it may reduce motivation and trust to the agement: Journal of the Healthcare Financial Management Association.
system. To improve this type of attitude it is better to take the 2005 May; 59(5): 112-113.
necessary acts in order to increase their awareness. 11. Terry AL, Thorpe CF, Giles G, Brown JB, Harris SB, Reid GJ. et al. Im-
plementing electronic health records: Key factors in primary care. Ca-
In a systematic review study, Hobbs(2002) indicated that nadian family physician/Medecin de famille canadien. 2008 May; 54(5):
healthcare providers have a few interests to use computers, 730-736.
but there is a positive correlation between their knowledge 12. Hier DB, Rothschild A, LeMaistre A, Keeler J. Differing faculty and
and attitude towards the use of computer (15). In the study housestaff acceptance of an electronic health record. International jour-
nal of medical informatics. 2005 Aug; 74(7-8): 657-662.
of Jebraeily et al. (2010) there were no significant between 13. Moody LE, Slocumb E, Berg B, Jackson D. Electronic health records
knowledge, attitude and computer skills (1). However, the documentation in nursing: nurses’ perceptions, attitudes, and prefer-
findings of the current study is not consistent with Hobbs and ences. Computers, informatics, nursing: CIN. 2004 Nov-Dec; 22(6):
Jebraeily`s studies. The reason may be because people aware- 337-344.
14. Richards H, King G, Reid M, Selvaraj S, McNicol I, Brebner E. et al.
ness of the advantages and disadvantages of the system has no Remote working: survey of attitudes to eHealth of doctors and nurses
equilibrium. This means that they may be more concerned in rural general practices in the United Kingdom. Family practice. 2005
about the potential disadvantages of the system and that’s why Feb; 22(1): 2-7.
they have negative attitudes. In overall, the average of nurses` 15. Hobbs SD. Measuring nurses’ computer competency: an analysis of
published instruments. Computers, informatics, and nursing: CIN.
readiness to implement EHR was 57.2%. In the study of Je- 2002 Mar-Apr; 20(2): 63-73.
braeily et al. (2010) it was 61.6% and the average of computer
skills, knowledge and attitude towards EHR was 55.6%,
60.8% and 68.4%, respectively (1).

ACTA INFORM MED. 2015 APR 23(2): 105-107 / ORIGINAL PAPER

View publication stats