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“The Effect of the Implementation of an Electronic Health Record on Nursing-Sensitive Patient Outcomes” A. Purpose and Context

Current policy in both the U.S. and U.K., as well as other developed countries, involves the introduction of information technology systems, such as electronic health records (EHR), computerized physician order entry systems (CPOE) and computerized decision support systems (CDSS) as a way of helping to improve the quality and safety of care that patients receive (Institute of Medicine 2001, Department of Health 2002). Key processes of decision making include information searching and the evaluation of knowledge to reach a judgment or decision (Thompson & Dowding 2002). Information technology systems may be designed to support some or all of these decision processes, with the assumption that improving the ability to identify evidence, or assist with the integration of evidence, will improve the quality of care patients receive. Such health care information technology systems certainly have the potential to improve care quality. For instance the use of CPOE systems has been linked to significant reductions in adverse drug events and medical error rates, by improving the legibility of drug orders and the provision of alerts for drug interactions (Wolfstadt et al 2008, Kaushal et al 2003). Other information technology systems such as CDSS can improve preventive health care delivery such as increased vaccination rates and diabetes management, through the provision of reminders and evidence based guidance (Chaudry et al 2006, Garg et al 2005). The use of information technology in health care has also been associated with decreased rates of health services utilization (Chaudry et al 2006). However, the introduction of information technology into health care may also have unintended consequences with negative effects on the quality of care that patients receive. Examples include physicians activating a medical order after the medication has actually been given (in an urgent situation), which means it could be given again once the order has been activated (Ash et al 2004), and nurses ‘manipulating’ a decision support system to give them the answer that fits with their assessment of the patient (Dowding et al 2009, O’Cathain et al 2004), potentially leading to an inaccurate assessment of the patient’s condition.