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Nurses’ Experiences of an Initial and Reimplemented Electronic Health Record Use

Chang, Chi-Ping PhD, RN; Lee, Ting-Ting PhD, RN; Liu, Chia-Hui MS, RN; Mills, Mary Etta ScD, RN

CIN: Computers, Informatics, Nursing: April 2016 - Volume 34 - Issue 4 - p 183–190
doi: 10.1097/CIN.0000000000000222

The electronic health record is a key component of healthcare information systems. Currently, numerous hospitals have adopted electronic health records to replace paper-based records to document care processes and improve care quality. Integrating healthcare information system into traditional nursing daily operations requires time and effort for nurses to become familiarized with this new technology. In the stages of electronic health record implementation, smooth adoption can streamline clinical nursing activities. In order to explore the adoption process, a descriptive qualitative study design and focus group interviews were conducted 3 months after and 2 years after electronic health record system implementation (system aborted 1 year in between) in one hospital located in southern Taiwan. Content analysis was performed to analyze the interview data, and six main themes were derived, in the first stage: (1) liability, work stress, and anticipation for electronic health record; (2) slow network speed, user-unfriendly design for learning process; (3) insufficient information technology/organization support; on the second stage: (4) getting used to electronic health record and further system requirements, (5) benefits of electronic health record in time saving and documentation, (6) unrealistic information technology competence expectation and future use. It concluded that user-friendly design and support by informatics technology and manpower backup would facilitate this adoption process as well.

Author Affiliations: Department of Nursing, Tzu Chi University of Science and Technology, Hualien (Dr Chang); School of Nursing, College of Nursing, National Taipei University of Nursing & Health Sciences, Taipei (Dr Lee); and Department of Nursing, Ditmanson Medical Foundation Chia- Yi Christian Hospital, Chiayi (Ms Liu), Taiwan; and School of Nursing, University of Maryland, Baltimore, MD (Dr Mills).

This work was supported by a grant [NSC-99-2314-B-227-006-MY3] to T.-T.L. from the National Science Council, Taiwan.

The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.

Corresponding author: Ting-Ting Lee, PhD, RN, School of Nursing, College of Nursing, National Taipei University of Nursing & Health Sciences, 365 Ming-Te Rd, Taipei 11219, Taiwan (

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