Measuring End-Users' Opinions for Establishing a User-Centred Electronic Health Record (EHR) System from the Perspective of Nurses

Article excerpt

Abstract

Establishing an acceptable user-centred electronic health record (EHR) system is a challenging task for healthcare providers due to the need for such systems to meet the requirements of its user population. Concerned nurses are the main end-users of EHR systems. Based on knowledge of evidence-based management (EBM) and the issues (goals and methods) of Health Information Systems (HIS) evaluation, this research was performed in four regional teaching hospitals by adopting a quantitative approach research design to perform "goal-based evaluation" research. The results of Path Analysis indicated that 17 of 21 hypotheses were accepted in this study. In addition, the results of One-way ANOVA with Scheff test comparisons indicated that Age is the most important variable in measuring System Quality, Service Quality, Safety Quality, User Use and User Satisfaction; Education is important in measuring Service Quality; and Seniority is important in measuring System Quality, Service Quality and User Use. Furthermore, the results of Linear regression indicated that only one hypothesis is affected by the demographic variable Education. In summary, this empirical investigation provided evidence-based knowledge to explain nurses' opinions of EHR systems success, and to distinguish which demographic variables influence their viewpoints of using such systems in southern Taiwan.

Key words: Electronic Health Records Systems, EHR evaluation, User-Centred Perspective, Socio-Technical Perspective, Evidence-Based Management

1 Introduction

In hospitals, a patient medical record involves all information and procedures that healthcare professionals perform in treating a patient, and an EHR system is adopted to record and offer sufficient data for decision-making in both the clinical service of patient care and the administration of health care. Indeed, the development of electronic health records (EHR) systems helps health professionals to enhance the quality of patient care and the efficiency of clinical services [1], since healthcare professionals are not only key stakeholders in patient care, but also end-users of such systems. The aim of establishing a successful EHR system is to improve efficiency, effectiveness, and to reduce medical errors, however an EHR system contains sensitive health data of individual patients [2].

Investing in EHR systems is a costly process. More specifically, establishing an acceptable user-centred EHR system is a challenging task for healthcare providers, due to such systems needing to meet the requirements of its user population. The importance of acceptable EHRs has been previously identified [3]. Moreover, developers who ignore stakeholder needs and work processes in designing an EMR system often fail in implementing EHRs [4]. Accordingly, it is necessary to consider and meet the requirements of stakeholders (end-users) to effectively apply EHRs in a real-world medical environment.

Health Information System (HIS) evaluation reflects on the relationship between the system user, the technology, and the medical environment [5], so it necessarily incorporates both human and organizational aspects [6]. HIS evaluation is not only a key consideration in determining whether a HIS is accepted by health professionals, but also to confirm whether the use of such a emphasized HIS helps/hinders the realization of such goals in a real-world medical environment [2]. Knowledge of evidence-based management (EBM) is used to generate and estimate the required supervision information for healthcare administration in hospitals [7]. The importance of stakeholders has been mentioned previously; therefore, HIS evaluation could be used to realize stakeholders' (end-users) opinions of using EHR systems. Accordingly, the application of HIS evaluation for EBM helps top-level executives to generate sufficient evidence-based information to support such important decision-making in adopting EHR systems. …