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Impacts of the Introduction of EHR in Nursing Practice


The dynamic change in technology has led to the way of executing work today. One such introduction in the medical industry includes Electronic health records. As a result of this, the quality of the health care given to the patients has improved constantly over a short period. The presence of this specialized software in the hospitals has led to several advancements in how the nurses perform their duties. Additionally, it has changed the overall quality of healthcare of the patients and the hospital in general. Today the benefits of the introduction of electronic health have been made known to everyone. The nurses have played a key role in the implementation of Electronic health records. This research aims to assess the impacts of the introduction of electronic health records in nursing institutions. Methods used in the research include the various descriptive cross-sectional studies on sectional of the nurse in Tehran university of medical sciences. During the employment of the cluster sampling, about 300 nurses gave their responses.

On the other hand, the use of the self-structured questionnaire was employed to help gather the data from the study. After the data collection, the resultant data was subjected to data management and analysis using the SPSS for window and descriptive statistics. The results of the research proved a lot to the researchers. There were about 85.9% took part in the research study. The results of the Microsoft word, which formed the 58.8% possess the higher level of skills and this was according to the ICDL. The overall attitude, computer skills for the nurses formed the 43.4% of the total nurses. The percentage of the nurse who proved to be much ready for the introduction of the electronic health record formed the 57.2 %. The comprehensive study’s conclusion proves the need for the nurses to be educated on the benefits of introducing electronic health records software to nursing institutions.

1.0 Introduction

There have been several significant technological advancements around the whole world in the medical industry (Balestra, 2017). One of the major significant change includes the Electronic health record. Electron health records imply how the data relating to the various patients usually get to be kept. This way, the patients’ medical history would be traced whenever the need arises and gets to be retrieved with ease. Therefore, the records include the classified, administrative hospital data and other elements concerning the demographics and patients’ medical progress reports. The patients’ information proves to be much secure with the employing of the Electronic health records have evolved so rapidly and entirely changed the way hospitals medical records preserved. The patient’s data information would be communicated from anywhere across the world without sending the physical documents that would take a longer period to get to the destinations required.

Additionally, laboratory reports and medical records would be shared among the healthcare centers found in different locations (Balestra, 2017). Electronic health records have entirely erased the traditional way of preserving the patient’s records through handwritten techniques such as the charts’ reliance. The EHR technique has resulted in the increased positive advancements witnessed today. Generally, health care professionals serve to understand and utilize medical resources efficiently to improve the patient’s outcomes in the healthcare centers.

Purpose of the Study

The reliance on Electronic Health Records’ use in the medical industry has witnessed improved advancement in medical information communication without incurring medical errors. Therefore, the reliance on the use of the HER has led to most health centers relying on the use on this electronic platform to preserve patient’s information. Electronic health record keeping has resulted in producing the most efficient and effective results outcomes for the patients. Regardless of the application of electronic health records in the medical industry, further research continues to be carried out by different researchers to unfold the several impacts of introducing the HER. Therefore, this research explores the impacts of the introduction of the EHR. The study would expose how the introduction of the HER has changed the way the nurses carry out their duties in terms of critical thinking, decision-making, and the degree of the improved care they give to their utmost patients.

Research Question

The study fully seeks to assess the impacts of the introduction of the EHRR in the nursing industry. The research questions were outlined as follows;

  1. What impacts have the introduction of EHRR brought to the quality of health care?
  2. What are the nurses, patients, and the general hospital’s attitudes due to their introduction in the nursing industry.?
  3. What has the EHRR impacts on the nurse’s critical thinking and decision-making due to the introduction of the EHRR?

Theoretical Framework

There have been additional factors that get to affect the way electronic health records (Balestra, 2017). For the EHR application to be successfully executed, the available nurses would need to have proper knowledge of the EHR software. Once the nurses have the efficient knowledge of the specialized software, they would get to make some proper knowledge regarding decision-making purposes, critical thinking, and judgment when analyzing the patient medical history. Additionally, the reliance on the same would help the nurses to engage in critical decision making after thorough consultation with one another.

2.0 Literature Review

The introduction of electronic health records was majored to improve the quality of the healthcare provider (Baumann et Al., 2018). On the other hand, it aimed to minimize the following errors that would otherwise cause complications. It would make it easier for the patients to access the HCP’s information during and after paying visits to the hospital centers. The development of the HER software was mainly developed in the 1960s, and it was mostly known to be a clinical information system. The American government started relying on the use of the HER in the late 1970s. They viewed the introduction of electronic health records as a technique that would help improve the health systems.

Another research also pointed out that the former president Barrack Obama fully supported the reliance on electronic health records in his American recovery and reinvestment act of 2009. From those years to date, most well-established medical centers rely fully on the use of the EHR to communicate interpersonally, proper check on the patients’ medical lab reports, and subsequent medical prescription purposes (Baumann et Al., 2018). Therefore, these medical departments would efficiently and effectively process the relevant patient’s orders with ease. For these reasons, the paper would unfold the benefits of applying electronic health records to make critical thinking and decision-making purposes. Through this path, the overall quality of medical healthcare would be increased effectively.

2.1 Impacts of the EHR Introduction in the Work of the Nurses

The nurse’s critical thinking capacity would greatly change (Baumann et Al., 2018). This is because the patients’ medical diagnosis would have to change. There would be the proper and correct interpretation of the patients’ medical results and the prescription done as per the patients’ medical history. Secondly, the decision making concepts also form part of the nurse’s practices that every medical facility has to rely on to perform appropriately. The conceits mentioned above generally interchange every day to help nurses perform their duties efficiently and effectively as required by the law. Critical thinking helps the nurses get to isolate the right medical records from the wrongs to offer their best to the patients. Therefore, the act of critical thinking forms part of the nurse’s professional lives today.

Decision making also forms part of the nurses work today (Baumann et Al., 2018). This is because the nurses would mostly arrive at the critical decisions after performing critical judgment, which relies on several factors. Critics’ decision-making entails the act of gathering the patient’s information from multiple sources and then analyzing it. The data collected on the patients includes the details surrounding the medical history and physical data concerns. Analysis of these data concerns would help provide more effective and efficient records—the data collected from the HER systems considered to be much relevant. The dependency of the two would help the nurses get the best out of their professional work experiences. Nurses get to increase their utmost knowledge whenever they continuously spend a lot of time interacting with the electronic software. Therefore, the electronic health records do not just serve the skills mentioned above but also among facilitators and informers in the medical fields.

As a result of the introduction of electronic health records, the nursing industry witnessed several advantages and disadvantages (Baumann et Al., 2018). The benefits of employing electronic health records’ introduction produce the benefits such as the proper monitoring of the patient’s medical records and progress. Therefore, the recommendation includes carrying out the screen tests, vaccinations, and assistance when it comes to providing the required patient’s medical prescriptions. On the other hand, several research studies assert that the challenges encountered with this software include the computer-based software would not fully understand the various clinical information such as dyspnea and the SOB. As a result, the nurses have to get down and make their full judgment before administering the medications. Most nurses resorted to not relying on the electronic health record fully but instead have to make a sound clinical decision. They resorted not to offload the whole work for the software to provide medical history.

Over the years, the EHR has served to be one of the most reliable platforms where the nurses would get to record the evidence found when carrying out the medical activities (Baumann et Al., 2018). Through this program, they would communicate the patients’ medical information, provide proper assessment and progress, evaluate the medical care for the patients, and note the patient’s progress. On the other hand, the nurses have increased their decision-making ability due to the medical evidence’s availability in the EHRR system. This software gives the most accurate, reliable, and complete medical records that improve the nurse’s ability to provide or arrive at a proper judgment on decision-making purposes.

2.3 Benefits of the Electronic Health Records to the Nurses

There have been mixed reactions and responses to the introduction of the EHR systems (Rathert et Al., 2019). The EHRR was d enveloped to aid in the efficiency of the healthcare teams. These teams composed of nurses were composed of the nurses who were expected to provide for the patients. As mentioned earlier, electronic health records’ benefits include the following; efficiency of clinical mentors, preventive care recommendations for the patients, effective diagnostic decision-making programs, and drug prescription assistance. EHRR would help them to get to understand the medical information and analyze the information. The software was considered to be one that has met the required standards with a view of providing accurate information. EHRR was thought to help relieve the nurse’s workloads and thereby improve care for the patients. As a result, they resorted to providing the research tool to gather the data, monitor and analyze them before prescribing the patient’s medications.

2.4 Impacts of the EHRR on the Patients and Hospital

Electronic health care records have become the well-known systems used in the medical field today (Rathert et Al., 2019). It has helped in providing easy access and the nurse’s feasibility when it comes to recording the data on the patients. The nurses get to access several reports on the patients concerning their health care.

A study carried out in the United States of America by one of the medical students on comparing electronic health records’ effectiveness related to the paperwork proves that the legal paperwork is abet sluggish. The student conducted most of the documenting and other activities such as perfuming bedside and non-bed side healthcare. The student’s findings resulted in the following findings; the reliance on the use of electronic health records by the nurses made their work to be abet less engaging compared to the paperwork that involved the reliance on the charts. This is because bedside care prompted the nurses to work to be abet engaged. Inters of the activates regarding the labor delivery medical centers, and the student noted that nurses spent aloof time attending to the patients throughout the day.

The use of the EHRR system prompted the nurses to access better information regarding the patients (Rathert et Al., 2019). It also essential to note that the nurses’ wrong usage of the EHRR by the nurses would incur constant errors by the medical facilities. This is because the incorrect application of the EHRR would interfere with the nurse’s ability to provide medical care standards to the patients, whether in or outpatients.

In some cases, the outcomes of the introduction of the EHRR resulted in the increased negative benefits in the nursing industry (Rathert et Al., 2019). The time duration which the patients were administered in the hospitals increased fully. According to a study carried out in Brigham. Another study on the women’s hospital found in Boston asserts that the dependency on the use of the women stay in the hospital was prolonged. In each of the research studies analysis, which argues that for each hospital stay in the hospital, the length would increase by 6.3 minutes for the overall stay and for the discharged patients, which was approximated to be 5.1 minutes. This was a result of the entry process in the edict system. According to the same study, it would mean that the treatments on the patients would be delayed by some duration whenever the study in the ED system. The electronic health records maximum strategizes itself by reducing the overall documentation processes which one had to undergo. Additionally, it would lessen the quantity of work incurred by the nurses.

A nether study carried out in Canada argues that the patients would have to incur a lot of time around the patients to offer their best medical care. This was not the case in the case in terms of relying on the EHR. For the study to be carried out appropriately, there were the assembling of around 767 nurses who came from the various 36 medical-surgical units

This study aimed to identify the factors that influence the professional work of the nurses in their workplaces (Rathert et Al., 2019). The data collected was subdivided into the various subcategories in which the nurses invested their professional time. The three categories included the following; 35%, allocated to the documentation aspects, which took around 147.5 minutes. The medication aspects took around 17.2 %, which took around 72minutes, while the rest took around 20.6%, which just took off about 86 minutes, and it was charged with the responsibility of medical care coordination. The documentation was given much priority to the nurse’s duties. In cases, the nurses would have to get to manage their daily time and the patient, and they would allow the patients to stay for a longer time while in the hospitals. The quality of the medical care administered to the patients would result in increased efficiency as they would concentrate on providing the best treatment compared to the patient’s information recording.

2.5 Impacts of the Application of EHR on the Nurse Environment

The patient’s results generally rely on the efficiency and effectiveness of the nurses who care for them (Kutney-Lee et Al., 2019). It is important to note that several factors aid in the quality of the healthcare provided by the various hospitals. These include the nurses’ job satisfaction, reduced turnover, and the urge to perform their duties from home. The introduction of electronic health records would result in a reduced number of employees as the workload would be left for the EHRR to execute.

In order to get the best out of the study, the nurses were randomly selected from the various units (Walker-Czyz & Fisher College, 2014b). These work observations from the results were entirely recorded in the SPSS. The data was then categorized independently into the available teams. Subsequently, these were recorded in terms of the five available categories. a) interruption source of interruption, types of interaction which includes the b) types of the interruptions and then interruption causes and the outcome of the interruptions. According to the reports carried out, there were 1600 interruptions, which took attest 800 observations hours. Most of the interruptions were argued to be due to the healthcare nurses ranging to 50 % of the total interruptions. These interruptions were categorized either as distractions, discrepancies and also breaks. According to the statistics, there were clear differences between the medical and the surgical units (f 1.685-5.602; p=0.1). The reports have that the nurses’ section mostly got interruptions that interface the patient’s assessments and the documentation concerns. The nurses were seen to undergo these interruptions mostly on the surgical floor compared to the medical floor. On the other hand, interruptions were viewed negatively as they would affect the patient’s safety concerns. (n =1,504, 89. 2%). There were fewer interruptions, which were argued to be in a position to improve patients care (n=183, 10.8%). These subsequent interruptions would result in medication delays, activities in the environment, and delays in the medications.

The limitation of the study suggests some limitations were witnessed during the study. These include the following limitations in terms of the sample size of the populations. Due to this, a lot of causation was witnessed in carrying out the study.

2.6 The Computerized Documentations and the Subsequent Quality Outcomes

The nurse who has the electronic health records’ verse knowledge would increase desirable attitudes towards the computerized documentation (Garcia, 2020). There were several descriptive and cross-sectional studies carried out in the United States to bring the best out of the study. Samples of the about 100 nurses were taken across the 23 units of the medical hospital. The instrument which was tasked with the sample study was the evidenced-based procedure. The results were as follows; about 36% of the 100 nurses argue that the adoption of the electronic health records would decrease the workload, while about 75% of the nurses argued that the EHRR has led to the improvement of the quality of the medical healthcare provided to the patients in terms of the documentation concerns. As a result of carrying out the research, some outcomes include the nurse’s perceptions, strengths, and other barriers to using electronic health records in medical facilities. The barriers that circumnavigate the reliance on the use of the electronic health records include the following: the duplicated documentation and increased disruption of the nurse’s workflow in the medical Centre. The other increased complaints on the nurses who argue that the patient’s rooms prove not conducive to installing the electronic health records.

Another research investigation employed using the aquatic experimental design was employed to deliver the nurses who rely on the EHR ((Garcia, 2020). The data was collected and analyzed to get the best out of the nurse’s experiences with the software adoption. This was assessed through the nurse’s attitudes towards the electronic health records questionnaire. The resulting outcomes of the instrument as it was seen to be much dependable. The Likert typed 1-5 scale had ranged from 20 to 100. The higher score on the scale fully indicated the positivity in terms of attitude. The Higher Score on the scale indicates the possibility of the patient medical care, benefit to the hospital, and the increased reliance on computer usage.

The study consists of the 46 nurses in pre and posts computerized documentation usage (Garcia, 2020). Such adoption of the standard descriptive and comparative statistics was employed to get to analyzed the study. The results were as follows; There were increase notable statistically significant difference (p=0.004) in terms of the nurse’s attitudes and perceptions on the introduction of the electronic health records. The study revealed the nurse’s perceptions and attitudes towards the subsequent decreased electronic health records reliance. According to the study, the scores were as follows; decrease scores where they argued that the computers make the nurses’ job easier (p<or equal 0.01; the computer saves the steps (p=0.02). There were increase electronic health records were seen increased costs. The nurse’s workload was seen to be increased due to the introduction of the EHRR. The study, which employed the 60 patient’s medical records review, was recorded and completed. There were overall improvements. From the study itself, several improvements were witnessed as a result of the introduction of the EHRR system.

3.0 Research Methodology

Research Questions

According to the various research studies in medicine, the reliance on the use of the EHRR has played an essential role in the nurse’s work. This is because it has enabled efficient communication of the patient’s data from different health center locations across the world. This has enabled and improved the patient’s outcomes in different hospitals. Regardless of these utmost benefits, there still needs more research on the impacts of adopting the EHRR in the nursing environment both to the nurses, hospitals, and the patients. Additionally, the other objective of the research study was the nurse’s perceptions and attitudes regarding the introduction of the EHRR to their normal practices. These duties about the daily interaction with the patients include critical thinking and decision making purposes.

Participants of the Study

In order to the best outcome in terms of findings for the research, several studies were conducted, which includes the qualitative analysis, mixed research method studies, and the literature review of the relevant research articles on the same topic of concern. Some of the research studies focused on targeting the registered nurse, which works in the hospital environments. On the issue of the impacts of EHRR introduction in the medical industry, some studies majorly focused on the nurse environment. In contrast, others focused entirely on the decision making the purpose of the nurses. The major concern of the paper includes the impacts surrounding the EHRR introduction in the nursing environment. The main reason why the contextual information on the nurses’ decision-making purposes was to provide information on the relevant nursing practices while undergoing their duties.

The qualitative research was meant to extend the nurses’ understanding of the need and use of the EHRR in their hospital practices. It helped a lot with the nurse’s understanding of the benefits of introducing the EHRR in the field of medicine. This is because accurate clinical practice is highly recommended in the nursing field. Therefore, the nursing institution would resort to adopting and integrating the EHRR in the medical industry.

Methods of Collecting Data

Several data collection methods were used in this research. These include the descriptive cross-sectional study, which relied on the cluster sampling techniques (Tubaishat, 2018). There were samples of the data obtained from the nurses who worked at the Tehran University of the medical hospital. Out of the 284 nurses were randomly selected to get the accurate data. There was a self-structured question are which was used as the tool to collect the data. This self -structured questionnaire was first divided into various four categories. Section one of the questionnaire consisted of the demographic information of the nurses. Section two of the questionnaire consists of the computer skills based on the ICDL measured using the Likert scale. Section three of the questionnaire outlined the fourteen questionnaires and were analyzed based on the nurse’s knowledge. The last section of the questionnaire outlined the twenty-three questions that source the nurse’s attitudes towards the EHRR adoption in providing quality treatment to the nurses. The available options for choosing from include agree, strongly agree, no consideration, disagree, and strongly disagree.

The concept of the validity of the questionnaire was evaluated to get the expert views on the same. The questionnaire was pretested, and then the data was analyzed to assess the consistency of the questions. The Cronbach α calculated to be (α= 0.82). While employing descriptive statistics, computer scores were recorded systematically. Again the frequency tables were then used to get to describe the details on the ordinal data. The relation in the computer skills knowledge was then put to the test using the spearman test value was estimated to be <0.05 and was given much thought as it was considered statistically significant. The data which resulted was then subjected to the statistical package of the social science SPSS.

Participants of the Computer Skills

Type of skill Mean Standard deviation Percentage
Initial concepts 2.50 0.73 50.0
Windows 2.44 0.74 48.8
Microsoft word 2.94 0.78 58.8
Microsoft excel 2.04 0.66 40.8
Microsoft access 1.23 0.48 24.6
m. PowerPoint 2.10 0.62 42.0
Email and internet 1.93 0.73 38.6

The participation in the research studies was carried out, and most of the nurses volunteered. The data collected was persevered with much confidentiality of the participants.


According to the study, over 85.9% of the total nurses consisted of around 77.5 %female, and 22.5%were approximated to be 22.5 male. The questionnaires were completed and then returned. The study’s mean was 32.44 and the mean years of the work experiences were estimated to be 8.75. Section of the total participants approximately 98.4%had a bachelor’s degree, and just 1.2% possess a master’s degree. Additionally, 86.3% of the total number possess about ICDL certificate.

Mean score for the nurse in terms of EHR,

Issues Mean SD Percentage
Promoting quality care 4.07 0.99 81.44
Proper Communication 4.36 0.75 87.2
Prevention of Errors 4.11 0.96 82.2
Preventing duplication 4.36 0.74 87.2
Enhance service delivery 3.79 1.10 75.8
Better Documentation 3.84 0.99 76.8
Timely Access information 4.32 0.74 86.4
Security and confidentiality EHR 2.50 0.99 50.0
Accuracy and Precision 3.97 0.74 79.4
Lower flexibility and modify 2.12 0.81 42.4
Satisfactory and simplicity 3.46 1.10 69.2
Improvement of work 3.34 1.07 66.8
Increased workload and time 2.33 1.06 46.6
Improve workflow 3.74 1.00 74.8
Endangered work position 2.30 0.77 46.0

According to the ICDL, the highest level of skill was Microsoft word, which was 58.8%, followed by access, which was about 24.6%. According to the studies, at least half of them would access the computers at home while the 32 %only rely on the computers at work. The dependency on the use of the emails was estimated to be around 28%. The mean score for the EHRR nurse was estimated to be 51.2%. Sections of the nurses possess some skills on the computer knowledge in the EHRR. Those who had vast knowledge in the EHRR represented about 19% of the total nurses. The other 33%represented the ones who were well conversant with the EHRR standards. These possess the highest knowledge of electronic health records, 75%. From the study, the main goals of the EHRR were mainly to get to initiate proper communication and the prevention of duplications. The negative attitude which surrounds EHRR was to complicate the service delivery of the hospitals. The nurse’s readiness for the adoption of the EHRR was approximated to be 57.2%. The other negative correlation was witnessed in the knowledge and attitude of the nurses.


This study aimed to assess the nurses in various hospitals on the impacts of EHR adoption. The nurses’ readiness for this adoption was research in computer skills, knowledge, and attitudes towards the EHR. The nurse’s readiness to introduce the HER was determined by the presence of the computer skills among the nurses and their knowledge on the implementation. Nurse such as physicians who possess computer knowledge entirely welcome the implementation of the EHRR. The reliance of the healthcare providers on the computers was approximated to be 59.5% while at their respective homes and 87%while at their respective workplaces. The dependency of the nurses on the emails was valued to be 88.2%. Another value of the clinicians who relied on the computers’ use was 55.4% and 53.6 %while at work. Subsequently, the reliance on the email chats was valued to be 59%. The available mean score for the Microsoft word skills was 75%, and access was 40%.

From the entire study, most nurses argue that the adoption of the EHRR would complicate the service delivery and complications to the entire system (Rathert et Al. 2019). This would result in the nurses’ lower motivation to get to work hard on their respective jobs. There would be some considerations that would be put in place to get to cover for the nurse’s awareness. Some of the studies argue that relying on the system would make most nurses shy away from working hard in their jobs. In other researcher studies where the nurse readiness for the implementation of the Electronic health records was considered to be 57.2%and these section represented the ones which were ready for the implementation of the EHR,


From the study, it would be shown that there is a level of computer knowledge which nurses would have to be well conversant with the implementation of the electronic health records. Therefore, the hospital’s facilities would need to get to conduct proper training of its employees on the need to adopt the computers in their daily work schedule. However, the nurse who got to possess a higher knowledge of the software had little interest in its introduction. Their attitudes and interest seemed to be much lower. In the schools and institutions of higher training, the electronic health records course was to be included in the curriculum of the studies. Electronic health records’ introduction needs to consider the following; training, education level of the nurses, and the nurse’s participation in its introduction.


Balestra, M. L. (2017). Electronic health records: patient care and ethical and legal implications for nurse practitioners. The Journal for Nurse Practitioners13(2), 105-111.

Baumann, L. A., Baker, J., & Elshaug, A. G. (2018). The impact of electronic health record systems on clinical documentation times: A systematic review. Health Policy122(8), 827-836.

Kruse, C. S., Stein, A., Thomas, H., & Kaur, H. (2018). The use of electronic health records to support population health: a systematic review of the literature. Journal of medical systems42(11), 1-16.

Kutney-Lee, A., Sloane, D. M., Bowles, K. H., Burns, L. R., & Aiken, L. H. (2019). Electronic health record adoption and nurse reports of usability and quality of care: the role of work environment. Applied clinical informatics10(1), 129.

Rathert, C., Porter, T. H., Mittler, J. N., & Fleig-Palmer, M. (2019). Seven years after Meaningful Use: Physicians’ and nurses’ experiences with electronic health records. Health care management review44(1), 30-40.

Tubaishat, A. (2018). Perceived usefulness and perceived ease of use of electronic health records among nurses: application of technology acceptance model. Informatics for Health and Social Care43(4), 379-389.

Vahdat, V., Griffin, J. A., Stahl, J. E., & Yang, F. C. (2018). Analysis of the effects of EHR implementation on timeliness of care in a dermatology clinic: a simulation study. Journal of the American Medical Informatics Association25(7), 827-832.

Walker-Czyz, A., & Fisher College, S. (2014b). The Impact of an Integrated Electronic Health Record Adoption on The Impact of an Integrated Electronic Health Record Adoption on the Quality of Nursing Care Delivered the Quality of Nursing Care Delivered.

Garcia, A. (2020). Nurses’ Perceptions of the Impact of the Electronic Health Record on Clinical Decision-Making. https:/

(PDF) Nurses Readiness and Electronic Health Records. (n.d.). ResearchGate. Retrieved January 23, 2021, from


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