Browse > Article
http://dx.doi.org/10.4040/jkan.2015.45.4.523

Identifying Usability Level and Factors Affecting Electronic Nursing Record Systems: A Multi-institutional Time-motion Approach  

Cho, Insook (Department of Nursing, Inha University)
Choi, Won-Ja (Department of Nursing, SMG-SNU Boramae Medical Center)
Choi, WoanHeui (Department of Nursing, Seoul National University Hospital)
Hyun, Misuk (Department of Nursing, Dongguk University Ilsan Hospital)
Park, Yeonok (Department of Nursing, Ajou University Hospital)
Lee, Yoona (Department of Nursing, Korea University Guro Hospital)
Cho, Euiyoung (Department of Nursing, Pai Chai University)
Hwang, Okhee (Department of Nursing, National Cancer Center)
Publication Information
Journal of Korean Academy of Nursing / v.45, no.4, 2015 , pp. 523-532 More about this Journal
Abstract
Purpose: The usability, user satisfaction, and impact of electronic nursing record (ENR) systems were investigated. Methods: This mixed-method research was performed as a time-motion (TM) study and a survey which were carried out at six hospitals between August and November 2013. The TM study involved 108 nurses from medical, surgical, and intensive care units at each hospital, plus an additional 48 nurses who served as nonparticipating observers. In the survey, 1879 volunteer nurses completed the Impact of ENR Systems Scale, the System Usability Scale, and a global satisfaction scale. Qualitative and quantitative analyses were performed. Results: The mean scores for the ENR impact, system usability, and satisfaction were 4.28 (out of 6), 58.62 (out of 100), and 74.31 (out of 100), respectively, and they differed significantly between hospitals (F=43.43, p<.001, F=53.08 and p<.001, and F=29.13 and p<.001, respectively). A workflow fragmentation assessment revealed different patterns of ENR system use among the included hospitals. Three user characteristics-educational background, practice period, and experience of using paper records-significantly affected the system usability and satisfaction scores. Conclusion: The system quality varied widely among the ENR systems. The generally low-to-moderate levels of system usability and user satisfaction suggest many opportunities for improvement.
Keywords
Electronic health records; Nursing records; Time and motion studies; User-computer interface; Work satisfaction;
Citations & Related Records
Times Cited By KSCI : 2  (Citation Analysis)
연도 인용수 순위
1 Krist AH, Beasley JW, Crosson JC, Kibbe DC, Klinkman MS, Lehmann CU, et al. Electronic health record functionality needed to better support primary care. Journal of the American Medical Informatics Association. 2014;21(5):764-771. http://dx.doi.org/10.1136/amiajnl-2013-002229   DOI   ScienceOn
2 Choi WH, Park IS, Shin HJ, Joo YH, Kim YA, Jung EH, et al. Comparison of direct and indirect nursing-care times between physician order entry system and electronic medical records. Studies in Health Technology and Informatics. 2006;122:288-293.
3 Shin A, Park HJ, Jung SJ, Park MH, Yoon KI, Kim YN. Analysis survey of user satisfaction with electronic nursing record system in a general hospital in Daegu. Journal of the Korean Society of Health Information and Health Statistics. 2009;34(1):29-39.
4 Zhou L, Soran CS, Jenter CA, Volk LA, Orav EJ, Bates DW, et al. The relationship between electronic health record use and quality of care over time. Journal of the American Medical Informatics Association. 2009;16(4):457-464. http://dx.doi.org/10.1197/jamia.M3128   DOI
5 Schumacher RM, Lowry SZ. NIST guide to the processes approach for improving the usability of electronic health records. Gaithersburg, MD: National Institute of Standards and Technology, 2010 November. Report No.: NISTIR 7741.
6 Middleton B, Bloomrosen M, Dente MA, Hashmat B, Koppel R, Overhage JM, et al. Enhancing patient safety and quality of care by improving the usability of electronic health record systems: Recommendations from AMIA. Journal of the American Medical Informatics Association. 2013;20(e1):e2-e8. http://dx.doi.org/10.1136/amiajnl-2012-001458   DOI   ScienceOn
7 Stevenson JE, Nilsson GC, Petersson GI, Johansson PE. Nurses' experience of using electronic patient records in everyday practice in acute/inpatient ward settings: A literature review. Health Informatics Journal. 2010;16(1):63-72. http://dx.doi.org/10.1177/1460458209345901   DOI   ScienceOn
8 International Organization for Standardization, International Electrotechnical Commission. Ergonomic requirements for office work with visual display terminals (VDTs) - Part 14: Menu dialogues [Internet]. Geneva, CH: Author; 1997 [cited 2014 November 1]. Available from: https://www.iso.org/obp/ui/#iso:std:16886:en.
9 Cho I, Choi WJ, Choi WH, Kim MK. The adoptions and use of electronic nursing records in Korean hospitals: Findings of a nationwide survey. Journal of Korean Clinical Nursing Research. 2013;19(3):345-356.   DOI
10 Zheng K, Guo MH, Hanauer DA. Using the time and motion method to study clinical work processes and workflow: Methodological inconsistencies and a call for standardized research. Journal of the American Medical Informatics Association. 2011;18(5): 704-710. http://dx.doi.org/10.1136/amiajnl-2011-000083   DOI   ScienceOn
11 Dykes PC, Hurley A, Cashen M, Bakken S, Duffy ME. Development and psychometric evaluation of the impact of health information technology (I-HIT) scale. Journal of the American Medical Informatics Association. 2007;14(4):507-514. http://dx.doi.org/10.1197/jamia.M2367   DOI   ScienceOn
12 Zhang J, Walji MF. TURF: Toward a unified framework of EHR usability. Journal of Biomedical Informatics. 2011;44(6):1056-1067. http://dx.doi.org/10.1016/j.jbi.2011.08.005   DOI   ScienceOn
13 DesRoches CM, Miralles P, Buerhaus P, Hess R, Donelan K. Health information technology in the workplace: Findings from a 2010 national survey of registered nurses. The Journal of Nursing Administration. 2011;41(9):357-364. http://dx.doi.org/10.1097/NNA.0b013e31822a7165   DOI   ScienceOn
14 Brooke J. SUS: A quick and dirty usability scale. In: Jordan PW, Thomas B, Weerdmeester BA, McClelland IL, editors. Usability evaluation in industry. London, UK: Taylor & Francis; 1996. p. 189-194.
15 Carrington JM, Effken JA. Strengths and limitations of the electronic health record for documenting clinical events. Computers, Informatics, Nursing. 2011;29(6):360-367. http://dx.doi.org/10.1097/NCN.0b013e3181fc4139   DOI
16 Agency for Healthcare Research and Quality. Time and motion study tool: Ambulatory practice (TMS-AP) [Internet]. Rockville, MD: Author; 2007 [cited 2014 November 1]. Available from: http://healthit.ahrq.gov/sites/default/files/docs/page/AHRQ%20NRC%20Time-Motion%20Study%20Tool%20Guide_0.pdf.
17 Song KJ, Kim EH, Yoo CS, Park HO, Park KO. Development of KPCS (Korean patient classification system for nurses) based on nursing needs. Journal of Korean Clinical Nursing Research. 2009; 15(1):5-17.
18 Bangor A, Kortum P, Miller J. Determining what individual SUS scores mean: Adding an adjective rating scale. Journal of Usability Studies. 2009;4(3):114-123.
19 Trafton J, Martins S, Michel M, Lewis E, Wang D, Combs A, et al. Evaluation of the acceptability and usability of a decision support system to encourage safe and effective use of opioid therapy for chronic, noncancer pain by primary care providers. Pain Medicine. 2010;11(4):575-585. http://dx.doi.org/10.1111/j.1526-4637.2010.00818.x   DOI   ScienceOn
20 Kim MS, Shapiro JS, Genes N, Aguilar MV, Mohrer D, Baumlin K, et al. A pilot study on usability analysis of emergency department information system by nurses. Applied Clinical Informatics. 2012; 3(1):135-153. http://dx.doi.org/10.4338/aci-2011-11-ra-0065   DOI   ScienceOn
21 Jung JH, Myung GH, Kang KH, Park EH. Analysis of standard nursing statements recorded in an electronic nursing record system and user satisfaction. Perspectives in Nursing Science. 2012;9(2): 146-153.
22 Kim DY, Park MH. Intermediate evaluation after the introduction of electronic nursing record system in a general hospital. Journal of Korean Clinical Nursing Research. 2010;16(3):133-144.
23 DesRoches CM, Campbell EG, Rao SR, Donelan K, Ferris TG, Jha A, et al. Electronic health records in ambulatory care-a national survey of physicians. The New England Journal of Medicine. 2008;359(1):50-60. http://dx.doi.org/10.1056/NEJMsa0802005   DOI   ScienceOn
24 Hendrich A, Chow MP, Skierczynski BA, Lu Z. A 36-hospital time and motion study: How do medical-surgical nurses spend their time? The Permanente Journal. 2008;12(3):25-34.
25 Yee T, Needleman J, Pearson M, Parkerton P, Parkerton M, Wolstein J. The influence of integrated electronic medical records and computerized nursing notes on nurses' time spent in documentation. Computers, Informatics, Nursing. 2012;30(6):287-292. http://dx.doi.org/10.1097/NXN.0b013e31824af835   DOI
26 Allen B. Knowledge organization in an information retrieval task. Information Processing and Management. 1990;26(4):535-542. http://dx.doi.org/10.1016/0306-4573(90)90073-B   DOI   ScienceOn
27 Allen B. Cognitive abilities and information system usability. Information Processing and Management. 1994;30(2):177-191. http://dx.doi.org/10.1016/0306-4573(94)90063-9   DOI   ScienceOn