Abstract
Electronic medical records (EMR) are generally used by nurses in hospitals. However, studies investigating views on and evaluations of EMR by nurses are limited in Turkey and in other countries around the world. In this study, nurses’ views on EMR systems were investigated in terms of “Nursing care management”, “Order entry”, “Information Management”, “Information quality”, “Service quality”, “Impact of EMR system on clinical care”. The purpose of this study was to investigate the views/perceptions on EMR used by nurses working at hospital clinics in Turkey. The research questions were: (a) What are nurses’ perceptions on EMR? (b) Were there relationships among nurses’ perceptions on EMR? (c) Were there differences among nurses’ perceptions on EMR according to hospitals in Turkey. This study is composed of field research conducted using questionnaires. To prepare the data-measuring instrument, the literature on EMR was reviewed. A Likert scale type was used in this questionnaire. The study was planned and conducted on nurses working at inpatient care units at four Turkish hospitals. At the end of this study, the questionnaire had been conducted on 517 nurses. Total response rate is 66.70 %. We found that the Information quality of EMR, impact of EMR system on clinical care and service quality were high level. Information quality has the highest mean score. EMR system is an important system for nurses’ hospital has the highest mean score in this study. Nurses feel about impact of EMR system on clinical care that generally ‘EMR system’s usefulness’, ‘improving quality of information due to EMR system’, ‘improving quality of nurses’ work’, ‘improving quality of information due to EMR system’. All of the six subscales of EMR were positively correlated with each other. This study revealed that there are significant differences among the mean scores for six subscales according to the ownership of hospitals. EMR systems were not well integrated into their workflow. In addition, half of all respondents had not been trained in using EMR systems. This study will added to evaluation views and assessments of nurses about EMR literature. The results will assist in determining “Information quality”, “Service quality”, of EMR, and “Impact of EMR system on clinical for nurses in Turkish health system”. This survey suggests that nurses favor the use of an EMR and suggests opportunities for EMR enhancement.
Similar content being viewed by others
References
Akdağ R (2008) Progress report, health transformation project in Turkey. Ministry of Health, Ankara
Aronsky D, Haug PJ (2000) Assessing the quality of clinical data in a computer-based record for calculating the pneumonia severity index. J Am Med Inform Assoc 7(1):55–65
Axford RI, Carter BEL (1996) Impact of clinical information systems on nursing practice/nurses’ perspectives. Comput Nurs 14:156–163
Ayyad Q (2002) Nursing satisfaction with the computerized nursing records. Paper presented at the meeting of nursing day, Oman
Barnette MT (2009) Lived experiences of registered nurses: impact of the electronic medical record. Doctor of philosophy thesis. School of Human Services, Capella University
Baron RJ, Fabens EL, Schiffman M, Wolf E (2005) Electronic health records: just around the corner? or over the cliff? Am Coll Physicians 143:222–226
Bates DW (2002) The quality case for information technology in healthcare. Med Inform Decision Mak 2:7–25
Burkle T, Ammenwerth E, Prokosch HU, Dudeck J (2001) Evaluation of clinical information systems. What can be evaluated and what cannot? J Eval Clin Pract 7:373–385
Chaudhry B, Wang J, Maglione M, Mojica W, Roth E, Morton SC et al (2006) Systematic review: impact of health information technology on quality, efficiency, and cost of medical care. Ann Intern Med 144:742–752
Cook TD, Campbell DT (1979) Quasi-experimentation design and analysis issues for field settings. Houghton Mifflin Company, Boston
Darr A, Harrison M, Shakked L, Shalom N (2003) Physicians’ and nurses’ reactions to electronic medical records systems. J Health Org Manag 17(5):349–359
Denny J, Giuse D, Jirjis J (2005) The Vanderbilt experience with electronic health records. Semin Colon Rectal Surg 16:59–68
Dillon T, Lending D, Crews T, Blankenship R (2003) Nursing self-efficacy of an integrated clinical and administrative information system. Comput Inform Nurs 21(4):198–205
Doğaç A, Hülür Ü, Çaylan AL, Yüksek M, Heywood J (2010) Country brief: Turkey. European Commission, DG Information Society and Media, ICT for Health Unit
Farsi AL, West DJ (2006) Use of electronic medical records in Oman and physician satisfaction. J Med Syst 30(1):17–22
Fraser HSF, Biondich P, Moodley D, Choi S, Mamlin BW, Szolovits P (2005) Implementing electronic medical record systems in developing countries. Inform Prim Care 13:83–95
Fung CH, Woods JN, Asch SM, Glassman P, Doebeling BN (2004) Variation in implementation and use of computerized clinical reminders in an integrated healthcare system. Am J Manag Care 10(2):878–885
Goorman E, Berg M (2000) Modelling nursing activities: electronic patient records and their discontents. Nurs Inquiry 7:3–9
Goossen WTF (1996) Nursing information management and processing: a framework and definition for system analysis, design and evaluation. Int J Biomed Comput 40:187–195
Hippisley-Cox J, Pringle M, Carter R, Wynn A, Hammersley V, Coupland C et al (2003) The electronic patient record in primary care-regression or progression? A cross sectional study. Br Med J 326:1439–1443
Howard R (2009) Nurse acceptance and perception of electronic medical record. Master of science thesis. Department of Advanced Nursing Studies, Northern Kentucky University, Kentucky
Jha AK, DesRoches CM, Campbell EG, Donelan K, Rao SR, Ferris TG, Blumenthal D (2009) Use of electronic health records in U.S. hospitals. N Engl J Med 360:1628–1638
Jha A, DesRoches C, Kralovec Pl, Joshi M (2010) A progress report on electronic health records in U.S. hospitals. Health Aff 29(10):1951–1957
Joos D, Chen Q, Jirjis J, Johnson KB (2006) An electronic medical record in primary care: impact on satisfaction, work, efficiency and clinic processes. AMIA Annu Symp Proc pp 394–398
Karsh BT, Beasley JW, Hagenauer ME (2004) Are electronic medical records associated with improved perceptions of the quality of medical records, working conditions, or quality of working life? Behav Inf Technol 23(5):327–335
Kazley AS, Ozcan YA (2007) Organizational and environmental determinants of hospital EMR adoption: a national study. J Med Syst 31:375–384
Kazley AS, Diana ML, Menachemi N (2011) The agreement and internal consistency of national hospital EMR measures. Health Care Manag Sci 14:307–313
Kirshbaum MN (2004) Are we ready for the electronic patient record? Attitude and perceptions of staff from two NHS trust hospitals. Health Inform J 10(4):265–276
Kossman S, Scheidenhelm S (2008) Nurses’ perceptions of the impact of electronic health records on work and patient outcomes. Comput Inform Nurs 26(2):69–77
Laerum H, Faxvaag A (2004) Task-oriented evaluation of electronic medical records systems: development and validation of a questionnaire for physicians. BMC Med Inform Decision Mak 4: 1 Available at http://www.biomedcentralcom/content/pdf/1472-6947-4-1.pdf. Accessed 10 April 2010
Laerum H, Ellingsen G, Faxvaag A (2001) Doctors’ use of electronic medical records systems in hospitals: cross sectional survey. Br Med J (BMJ) 323:1344–1348
Lee FW (2000) Adoption of electronic medical records as a technology innovation for ambulatory care at the medical university of South Carolina. Health Inform Manag 21(1):1–20
Lee TT (2004) Evaluation of computerized nursing care plans: instrument development. J Prof Nurs 20(4):230–238
Lee T (2007) Nurses’ experiences using a nursing information system. Comput Inform Nurs 25(4):294–300
Lee TT, Yeh CH, Ho LH (2002) Application of a computerized nursing care plan system in one hospital: experience of ICU nurses in Taiwan. J Adv Nurs 39(1):61–67
Lee TT, Lee TY, Lin KC, Chang PC (2005) Factors affecting the use of nursing information systems in Taiwan. J Adv Nurs 50(2):170–178
Li J, Zhang X, Chu J, Suzuki M, Araki K (2012) Design and development of EMR supporting medical process management. J Med Syst 36:1193–1203
Likourezos A, Chalfin DB, Murphy DG, Sommer B, Darcy K, Davidson SJ (2004) Physician and nurse satisfaction with an electronic medical record system. J Emerg Med 27(4):419–424
Mekhijian HS, Kumar RR, Kuehn L, Bentley TD, Teater P, Thomas A, Payne B, Ahmad A (2002) Immediate benefits realized following implementation of physician order entry at an academic centre. J Am Med Inform Assoc 9(5):529–539
Miller R, Sim I (2004) Physician’s use of electronic medical records: barriers and solutions. Health Aff 23(2):116–126
MoH (Turkish Misnitry of Health) (2010) Progress report, health transformation project in Turkey. Ministry of Health, Ankara
Ngin P, Simms LM, Erbin-Roesemann M (1993) Work excitement among computer users in nursing. Comput Nurs 11:127–133
O’Mahony D, Banach L, Mahapa D et al (2002) Teledermatology in a rural family practice. South Afr Fam Pract 25:4–8
Otieno GO, Hosoi R (2005) Factors influencing diffusion of electronic medical records: a case study in three healthcare institutions in Japan. Health Inform Manag J 34(4):120–129
Otieno OG, Toyama H, Asonuma M, Kanai-Pak M, Naitoh K (2007) Nurses’ views on the use, quality and user satisfaction with electronic medical records: questionnaire development. J Adv Nurs 60(2):209–219
Pizzi LT, Suh DC, Barone J, Nash DB (2005) Factors related to physicians’ adoption of electronic prescribing: results from a national survey. Am J Med Qual 20:22–32
Roemer LK, Richardson SJ, Sward K, Tilley C (2005) Redundancy in a computer-generated order list: meeting the needs of nurses at various levels of practice expertise. Comput Inform Nurs 23(2):73–82
Rotich JK, Hannan TJ, Smith FE et al (2003) Installing and implementing a computer-based patient record system in sub-Saharan Africa: the Mosoriot medical record system. J Am Med Inform Assoc 10:295–303
Shortliffe EH, Cimino JJ (2006) Biomedical informatics: computer applications in health care and biomedicine, 3rd edn. Springer Publication, New York
Sitting D, Kuperman G, Fiskio J (1999) Evaluating physician satisfaction regarding user interactions with electronic medical records system. Proc AMIA Symp pp 400–404. Available at www.Amia.org/pubs/symposia. Accessed 10 Dec 2009
Stormo A, Sollid S, Stormer J, Ingebrigtsen T (2004) Neurosurgical teleconsultations in northern Norway. J Telemed Telecare 10:135–139
Van Bemmel JH, Musen MA (1997) A handbook of medical informatics. Springer-Verlag, Heidelberg
Wakefield D, Halbesleben J, Ward M, Qui Q, Brokel J, Crandall D (2007) Development of a measure of clinical information system expectations and experiences. Med Care 45(9):884–890
Walsh SH (2004) The clinician’s perspective on electronic health records and how they can affect patient care. Br Med J 328:1184–1187
Wolf D, Greenhouse P, Diamond J, Fera W, McCormick D (2006) Community hospital successfully implements eRecord and CPOE. Comput Inform Nurs 24(6):307–316
Acknowledgments
The authors are grateful to several anonymous reviewers for their very helpful comments.
Author information
Authors and Affiliations
Corresponding author
Appendix 1
Appendix 1
An example questionnaire form
Items of the EMR system | 1 2 3 4 5 | |
---|---|---|
To what extent do you use the EMR system for each of the following tasks? | ||
Nursing care management | 1 | 5 |
Never/almost never/not at all | Always/almost always | |
1. Reviewing the patients problems | ||
2. Entering daily nursing care notes | ||
3. Capturing patient observations at the bedside | ||
4. Writing nursing care plans | ||
5. Writing nurse care worksheets (Kardex) | ||
6. Collecting patients info for discharge reports | ||
7. Documenting physical assessment of patients | ||
Frequency of use of order entry | ||
8. Obtaining information on investigation or treatment procedures | ||
9. Obtaining the results from new tests or investigations | ||
10. Answering questions concerning general medical knowledge (concerning treatment, symptoms, complications, etc.) | ||
11. Obtaining results of tests and investigations | ||
12. Checking drug information (such as allergy and interactions) | ||
Information management | ||
13. Seeking out specific information from patient records | ||
14. Produce data reviews for specific patient groups, e.g. complication rate, diagnoses, etc | ||
15. Giving written individual information to patients, e.g. about medications, disease status | ||
In your hospital, to what extent | ||
Information quality | 1 | 5 |
Not at all | Very great | |
16. Degree of EMR system’providing the precise information you need | ||
17. Degree of EMR system’s meeting your information needs | ||
18. Degree of EMR systems’s provideing reports that seem to be just exactly what you need | ||
19. Degree of EMR system’s providing sufficient information | ||
20. Degree of EMR system’s accuracy | ||
21. Degree of satisfaction with the accuracy of EMR system | ||
22. Degree of thinking the output is presented in a useful format | ||
23. Degree of information clearance | ||
24. Degree of EMR system’s user-friendship | ||
25. Degree of getting the information you need in time | ||
26. Degree of EMR system’s provide up-to-date information | ||
Service quality | ||
27. Degree of counting on the system to be up and available | ||
28. Degree of EMR system’s problems and crashes | ||
Impact of EMR system on clinical care | ||
29. Degree of feeling EMR system’s usefulness | ||
30. Degree of improving nurses’ performance due to EMR system | ||
31. Degree of improving quality of nurses’ work | ||
32. Degree of feeling EMR is worth the time and effort required to use it | ||
33. Degree of feeling improving quality of information due to EMR system | ||
34. Degree of feeling EMR system has been successful in your hospital | ||
35. Degree of feeling EMR system is an important system for your hospital | ||
36. Degree of training in using EMR systems | ||
37. Degree of computer workstation’s deranging your workflow | ||
38. Degree of impeding of the lack of staff computer skills the use of EMR system | ||
39. Degree of workstations’ availability for use by nurses | ||
40. Degree of well integrating computerized documentation into the workflow |
Rights and permissions
About this article
Cite this article
Top, M., Yilmaz, A. & Gider, Ö. Electronic Medical Records (EMR) and Nurses in Turkish Hospitals. Syst Pract Action Res 26, 281–297 (2013). https://doi.org/10.1007/s11213-012-9251-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11213-012-9251-y