The benefits of introducing electronic health records in residential aged care facilities: A multiple case study

PURPOSE Information and communications technology solutions have been introduced into the residential aged care system in order to improve the effectiveness and efficiency of aged care, however to date, the actual benefits have not been systematically analysed. The aim of this study was to identify the benefits of electronic health records (EHR) in residential aged care services and to examine how the benefits have been achieved. METHOD A qualitative interview study was conducted in nine residential aged care facilities (RACFs) belonging to three organisations in the Australian Capital Territory (ACT), New South Wales (NSW) and Queensland, Australia. A longitudinal investigation after the implementation of the aged care EHR systems was conducted at two data points: January 2009 to December 2009 and December 2010 to February 2011. Semi-structured interviews were conducted with 110 care staff members selected through theoretical sampling, representing all levels of care staff who worked in those facilities. RESULTS Three categories of benefits were perceived by the care staff members according to who gain the benefits: the benefits to individual care staff members, to residents and to the RACFs. The benefits to individual care staff members include an improvement of documentation efficiency, information and knowledge growth as well as empowering the staff; the benefits to residents are an improvement in the quality of individual residents' health records, the higher quality of care and smoother communication between the residents and aged care staff; the RACFs gain an increased ability to manage information and acquire funding, an increase in their ability to control the care quality and improvements in the working environment and educational benefits. Three factors leading to these benefits were examined: the nature of the aged care EHR systems in comparison with paper-based records; the way the systems were used by the staff and one benefit that could lead to another. CONCLUSIONS In this study, EHR systems were perceived to have substantial benefits for care staff, residents and the aged care organisations introducing the systems. The benefits were derived from the nature of the aged care EHR systems, staff members' continuous use of the systems, and one benefit led to the other.

[1]  Kaija Saranto,et al.  Definition, structure, content, use and impacts of electronic health records: A review of the research literature , 2008, Int. J. Medical Informatics.

[2]  Hsiu-Fang Hsieh,et al.  Three Approaches to Qualitative Content Analysis , 2005, Qualitative health research.

[3]  C. Yowler,et al.  Validation of Surgical Intensive Care-Infection Registry: a medical informatics system for intensive care unit research, quality of care improvement, and daily patient care. , 2008, Journal of the American College of Surgeons.

[4]  G. Paré,et al.  Toward a multidimensional assessment of picture archiving and communication system success , 2005, International Journal of Technology Assessment in Health Care.

[5]  Jim Warren,et al.  Introduction of electronic prescribing in an aged care facility. , 2005, Australian family physician.

[6]  Gregory L. Alexander,et al.  Effects of a computerized decision support system on pressure ulcers and malnutrition in nursing homes for the elderly , 2011, Int. J. Medical Informatics.

[7]  P Wainwright,et al.  Nursing record systems: effects on nursing practice and health care outcomes. , 2003, The Cochrane database of systematic reviews.

[8]  Diane Buchanan,et al.  Social Support and Long-Term Survivors of AIDS , 1997, Western journal of nursing research.

[9]  Chia-Cheng Chao,et al.  Measuring mobile patient safety information system success: An empirical study , 2008, Int. J. Medical Informatics.

[10]  P. Cochat,et al.  Et al , 2008, Archives de pediatrie : organe officiel de la Societe francaise de pediatrie.

[11]  Ephraim R. McLean,et al.  The DeLone and McLean Model of Information Systems Success: A Ten-Year Update , 2003, J. Manag. Inf. Syst..

[12]  B. Lundman,et al.  Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. , 2004, Nurse education today.

[13]  John B. Shoven,et al.  I , Edinburgh Medical and Surgical Journal.

[14]  Stacie Petter,et al.  Evaluating the success of an emergency response medical information system , 2011, Int. J. Medical Informatics.

[15]  Karin Garrety,et al.  A preliminary investigation of complex adaptive systems as a model for explaining organisational change caused by the introduction of health information systems , 2011 .

[16]  S. Foster Doing business research: a guide to theory and practice , 2012 .

[17]  Anselm L. Strauss,et al.  Basics of qualitative research : techniques and procedures for developing grounded theory , 1998 .

[18]  Saonee Sarker,et al.  Examining the success factors for mobile work in healthcare: A deductive study , 2009, Decis. Support Syst..

[19]  A. Strauss,et al.  The discovery of grounded theory: strategies for qualitative research aldine de gruyter , 1968 .

[20]  Paul Turner,et al.  Utilisation of mobile handheld devices for care management at an Australian aged care facility , 2006, Electron. Commer. Res. Appl..

[21]  Ping Yu,et al.  The changes in caregivers' perceptions about the quality of information and benefits of nursing documentation associated with the introduction of an electronic documentation system in a nursing home , 2011, Int. J. Medical Informatics.

[22]  P. Shekelle,et al.  Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care , 2006, Annals of Internal Medicine.

[23]  Gerard J Fitzsimmons,et al.  From the Australian Institute of Health and Welfare , 2014, Communicable diseases intelligence quarterly report.

[24]  Andrew Dalley,et al.  The introduction of electronic medication charts and prescribing in aged care facilities: An evaluation , 2007 .

[25]  Maria Hägglund,et al.  Health informatics and the delivery of care to older people. , 2009, Maturitas.

[26]  Marilyn Rantz,et al.  Clinical Information Systems in Nursing Homes: An Evaluation of Initial Implementation Strategies , 2007, Computers, informatics, nursing : CIN.

[27]  Ping Yu,et al.  How nursing staff spend their time on activities in a nursing home: an observational study. , 2011, Journal of advanced nursing.

[28]  R. Watson,et al.  Review: evaluating information systems in nursing. , 2008, Journal of clinical nursing.

[29]  E. B. Steen,et al.  The Computer-Based Patient Record: An Essential Technology for Health Care , 1992, Annals of Internal Medicine.

[30]  David B Reuben Systems approaches to improve quality, performance, and efficiency in the care of older adults. , 2007, The Permanente journal.

[31]  C. A. Schorr Validation of Surgical Intensive Care-Infection Registry: A Medical Informatics System for Intensive Care Unit Research, Quality of Care Improvement, and Daily Patient Care , 2009 .

[32]  S. Lindner,et al.  An Electronic Medical Record Intervention Increased Nursing Home Advance Directive Orders and Documentation , 2007, Journal of the American Geriatrics Society.

[33]  George Ochieng Otieno,et al.  Measuring effectiveness of electronic medical records systems: Towards building a composite index for benchmarking hospitals , 2008, Int. J. Medical Informatics.

[34]  Shelly Dubin,et al.  When the patient suffers: optimization of transitions between care facilities. , 2007, Geriatric nursing.

[35]  A. Martin,et al.  Documentation practices of nurses in long-term care. , 1999, Journal of clinical nursing.

[36]  Helaine E. Resnick,et al.  Use of electronic information systems in nursing homes: United States, 2004. , 2009, Journal of the American Medical Informatics Association : JAMIA.

[37]  Sue J Irvine,et al.  An ICT Solution for Medical Care to Residents in Residential Aged Care Facilities , 2010, Health information management : journal of the Health Information Management Association of Australia.

[38]  Christine Urquhart,et al.  Nursing record systems: effects on nursing practice and healthcare outcomes. , 2009, The Cochrane database of systematic reviews.

[39]  Zvisinei Sandi DEFINITION , 1961, A Philosopher Looks at Sport.

[40]  S. Simmons,et al.  Accuracy of Nursing Home Medical Record Information about Care‐Process Delivery: Implications for Staff Management and Improvement , 2004, Journal of the American Geriatrics Society.

[41]  Nigel H. Lovell,et al.  A Clinical Monitoring and Management System for Residential Aged Care Facilities , 2006, 2006 International Conference of the IEEE Engineering in Medicine and Biology Society.

[42]  D. Pierce,et al.  An investigation of medication information transfer and application in aged care facilities in an Australian rural setting. , 2009, Rural and remote health.

[43]  Ping Yu,et al.  Does the introduction of an electronic nursing documentation system in a nursing home reduce time on documentation for the nursing staff? , 2011, Int. J. Medical Informatics.

[44]  Ning Wang,et al.  Quality of nursing documentation and approaches to its evaluation: a mixed-method systematic review. , 2011, Journal of advanced nursing.

[45]  C. Brodsky The Discovery of Grounded Theory: Strategies for Qualitative Research , 1968 .