NURS 300: Assignment 9 - Critique of EHR Implementation Research Study

This report critically analyzes a research paper titled "Electronic Health Record (EHR) Organizational change: explaining resistance through profession, organizational experience and EHR communication quality" (Barrett, 2018). The paper investigated the impact of EHR implementation, mandated by the American Recovery and Reinvestment Act of 2009, on healthcare organizations. The study surveyed 345 employees, finding resistance to change, particularly among tenured nurses and practitioners. The research utilized variance analysis, the job characteristics model, and hierarchical regression to evaluate the changes associated with the implementation of EHR within the healthcare setting. The report critiques the paper's structure, conceptual framework, methodology (including the use of a quantitative design and a pilot study), participant selection, procedures, data analysis (ANOVA test and qualitative scales), and results, which were presented under two hypotheses. The discussion section's clarity and use of supporting literature are also assessed. The report highlights both the strengths and weaknesses of the research, providing a comprehensive overview of the study's design, execution, and findings.

Running head: NURSING ASSIGNMENT
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Name of the Student:
Name of the University:
Author Note:

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Overall Summary:
The U.S government passed the American Recovery and Reinvestment Act in the
year 2009, by virtue of which all healthcare organizations are entitled to adapt an electronic
healthcare record system and failure to implement to the same could lead to serious
implications such as imposition of Medicare reimbursement penalties which could shoot up
with each year of negligence. In order to evaluate the changes associated with the
implementation of EHR within the healthcare setting, the research hers conducted an
organizational survey to evaluate the consequences associated with the implementation of
HER within a specific healthcare setting. A total of 345 employees were surveyed who were
working in a specific healthcare organization and where the electronic health record system
was recently implemented. The overall findings of the research study was evaluated through
variance analysis and it was found that the organization change was mostly resisted by the
group of nurses and practitioners who were tenured within the organization. The researchers
made use of the job characteristics model to explain the findings and the hierarchal regression
analysis to explain the quality of communication that was associated with the implementation
of EHR. On the basis of evaluation of the quality of communication it was found that both the
informal and the formal form of communication were negatively associated with EHR
implementation but were positively associated with the positive advantages of implementing
EHR within the healthcare system.
Title:
The title of the research paper is “Electronic Health Record (EHR) Organizational
change: explaining resistance through profession, organizational experience and EHR
communication quality’ (Barrett, 2018). On critically analysing the content of the research

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paper it can be said that the title of the research paper is appropriate and is critically aligned
to the content of the research paper.
Abstract:
The abstract of the paper presents an overview about the research paper and helps the
readers gain an insight into the research design chosen by the researchers to conduct the
study. Further, the abstract also presents an overview about the analysis methods that was
chosen in order to evaluate the collected results. It also presented a precise insight to the
overall findings of the research study. However, it is integral to note in this context that the
abstract of the paper is not structured and is written in a conventional manner. However, the
positive aspect of the abstract can be mentioned as the detailed information it provided about
the research methodology i.e; a survey and the number of participants that participated in the
survey. Also, the statistical method that was used to interpret the findings of the survey was
also explained in an elaborate manner by the researcher which enabled the readers to acquire
an enhanced understanding about the overall content of the research paper.
Introduction:
The research paper presented an elaborate background in relation to the American
Recovery and Reinvestment Act that was passed by the US in the year 2009 and the set of
healthcare challenges that inspired the implementation of EHR across healthcare
organizations. However, one of the limitations would include the lack of a proper structure
which would specify the Introduction section in the research paper. In addition to this, the
introduction section is more focused on the historic background of the American Recovery
and Reinvestment Act and does not include a proper research question to direct the readers
and make them understand about the significance of the research. As stated by Morse (2016),
a research question is an integral element of any research paper as it helps to understand the

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literature gap and the research aptitude of the researcher to adapt measures and devise an
appropriate research question. The entire content of the research paper particularly the
methodology and the results section is critically based on the articulation of the research
question and the devised research objectives. Therefore, it can be said that the introduction
section of the research paper lacked clarity and a proper structured content.
Conceptual Framework:
The research study lacked a proper conceptual framework and there was no section in
the research paper that explained the philosophical underpinnings or assumptions of the
research. Due to the lack of an explanation about the conceptual framework of the research,
the authenticity and credibility about the philosophical underpinnings of the research is
questionable (Barrett, 2018).
Method:
The methodology section was clearly described in the research paper and included
several subsections that explained each aspect of the quantitative analysis that was
undertaken to analyse the survey results. The researchers conducted a pilot survey in order to
evaluate three assumptions that included whether or not the instructions mentioned in the
questionnaire were comprehensible, whether or not the proposed research instruments and
methods were appropriate and to analyse the face validity of the survey. The positive aspect
can be mentioned as the elaborate section on the pilot study that critically testifies that the
research design and the research instrument used for conducting the study was feasible.
Further, the methodology section also presented in detail about the research site and the
participants and the data collection method that was used for the research study. In the words
of Brannen (2017), a credible research study comprises of a clear methodology section that
presents in detail about the research instruments and the sample size that were included in the

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research paper. Therefore, it can be said that the methodology section of the paper was well
written with proper sub-headings that made it easier for the reader to understand the chapter.
Design:
On critically analysing the research paper, it can be mentioned that the researchers
made use of a quantitative research study design that ideally suited the purpose of the
research. The purpose of the research was to analyse the factors that were tightly linked with
the organizational change post implementation of the electronic healthcare record system
within the healthcare organizations. According to McCusker and Gunaydin (2015), a
quantitative research design is appropriate for conducting a research study that intends to
evaluate the impact of an intervention on the overall functioning of an organization.
Therefore, it can be mentioned that the quantitative research design that was selected by the
researchers was appropriate and aligned with the purpose and objectives of the research
study.
Participants:
The pilot study included a total of 28 participants that were selected from the
healthcare organization and the total strength of the selected participants comprised of 50%
physicians, 25% nursing professionals, 8% administration staff, 8% technicians and 8%
medical assistants (Barrett, 2018). The selection of the participants for the pilot study can be
mentioned as appropriate. In addition to this, the varying percentage of the healthcare
professionals included in the sample size suggest that the sampling was not biased and that
the sample size comprised of care professionals from every domain. In addition to this, it
should also be mentioned that the participants that were included in the primary study
comprised of a total of 345 healthcare employees who were employed in different domains of
healthcare (Barrett, 2018). Also the response rate of the survey was equivalent to 71% which

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indicates that the participants proactively participated in the survey response process (Barrett,
2018). Considering the sample size for the pilot study as well as the primary survey it can be
said that an appropriate sampling procedure was followed and an appropriate sample strength
was included in the research study which permits the generalization of the results and
findings of the research study.
Procedures:
The research study comprised of an experimental survey as the research instrument.
The survey was conducted based on a set of questionnaire, which comprised of questions that
evaluated the attitude and perception of the healthcare professionals with respect to the
implementation of electronic healthcare record within the healthcare organization. It should
be noted in this context, that research studies ideally mention that the use of a survey is an
effective research instrument that helps to analyse results and interpret existing relationship
between diverse data set. As stated by Bryman (2017), survey analysis provide an improved
insight about the perception of a diverse sample size for multiple research parameters. In this
case as well, the researchers intended to evaluate the attitude and perception of the different
healthcare professionals with regard to the implementation of the EHR system within the
healthcare system. Therefore, the choice of survey design as the research instrument can be
considered appropriate and aligned to the objectives of the research.
Data Analysis:
The data analysis was conducted in a rigorous manner and statistical analysis methods
were used for the analysis of the collected data set. It should be noted in this context that
ANOVA test was used in order to evaluate the data findings. As informed by the evidence
base, the ANOVA test is an excellent statistical method that helps to analyse a data set and
deduce existing relationship between two or more entities. In addition to this, Barnham

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(2015) suggests that the use of ANOVA test serves an excellent statistical tool that guides the
evaluation and establishment of a statistically significant result. Further, the survey results
also revealed several qualitative findings in relation to attitude and perception. For the
evaluation of the qualitative factors, the researchers made use of appropriate qualitative scale
such as the Likert scale was used for rating the coping skills of the organization post
implementation of the electronic health record system. The Mohr and Benbasat’s scale was
used to assess EHR relevant advantage and the Mohr and Sohi’s scale was used to assess the
quality of EHR change communication (Barrett, 2018). This indicated that the researchers
critically considered both the qualitative as the quantitative aspect of the research study and
employed appropriate analysis methods to discuss the results. The choice of methods for both
the qualitative and quantitative data is thus appropriate and aligned to the objectives of the
research study.
Results:
The result section was explained in a detailed manner under two broad hypothetical
assumptions. The two hypothesis included, relationship between the employee profession,
organizational experience and resistance and relationship between implementation success,
relative advantage and resistance and communication quality. Further under each of the
hypothesis, adequate information was provided with precision and tables of data sets were
used so as to help the readers develop a clear understanding about statistically significant
results. To test the first hypothesis a one way ANOVA test was conducted which revealed a
statistically significant result that profession impacted level of resistance. Correlational
statistics suggested the variables of implementation success, relative advantage resistance and
the communication quality were interrelated. The choice of the independent variable (EHR
implementation) and dependent variables (implementation success, relative advantage
resistance and communication quality) were appropriate and the three hypothesis were

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supported by three significant statistical analysis methods that included hierarchal multiple
regression, correlational statistics and ANOVA.
Also, the statistically significant results were discussed with the use of supporting literatures
which suggest that the results were backed with resources from the evidence base. Overall,
the result section was written in a lucid manner and was explained rigorously which
promoted effective understanding of the statistically significant data.
Discussion:
The discussion section was also written in a clear and concise manner. The
statistically significant results were explained properly with the use of supporting scholarly
resources from the evidence base. Both the themes were described appropriately with a
number of research studies that supported the validity of the findings of the researcher. At the
end of the discussion section, the researchers also discussed about the scope of future studies
and vividly discussed the advantages that are associated with the successful implementation
of the research studies. Overall, the discussion section was written appropriately with the use
of relevant research journals that supported and confirmed the credibility of the acquired
findings. In the words of Noble and Smith (2015), research studies that make use of
appropriate and relevant scholarly journals to support the findings are credible primary
sources. Also, research studies that offer an insight to the scope of future studies are
considered credible as they offer a set of guidelines to the future researchers to design their
future research (Patten & Newhart, 2017).
Other Comments:
In addition to the above findings, the research paper also contains a precise section on
the limitations of the research study. The researchers have adequately highlighted the risk of
bias present in the research study and the problem with the sampling technique.

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Also a concluding paragraph was mentioned which appropriately concluded the
findings of the research and presented the scope of future studies which could be considered a
research guideline by the future researchers. Therefore, overall the research study can be
considered credible. Specifically, the choice of the methodology, research design and
research instrument can be considered appropriate that complement the objectives and
purpose of the research study.
Presentation:
The presentation of the research paper can be considered poor in terms of lack of
proper structured paragraphs in certain sections such as the Introduction section and the
Methodology section. Also, the absence of a clear research question can be pointed out as a
major lacunae of the paper. Certain segments of the paper are written in a haphazard manner
and lack clarity. These factors make it difficult for the reader to understand the content. Also,
the Introduction section focuses excessively on the historical background information which
is not required as it does not lead to a proper research question or research aim.
Ethical Aspects:
As suggested by Watson (2015), ethical aspects form an integral segment of any
research study. While making use of research instruments such as surveys or interviews, it is
extremely important to abide by the ethical considerations and maintain anonymity of the
participants. Violation of these consideration could lead to breach of privacy. As informed by
the researchers, the research was conducted abiding by the set of ethical considerations.
Anonymity of the participants who participated in the survey was maintained. Also, the real
identity of the healthcare organization where the research was conducted was kept
confidential and a pseudo name was used abiding by the set of ethical considerations. Also,
the research study was conducted only after obtaining the ethical consideration from the

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healthcare organization. Therefore, it can be mentioned that none of the ethical considerations
were violated and the research study was conducted adhering to the ethical considerations
which again serves as a strength of the research study.

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References:
Barnham, C. (2015). Quantitative and qualitative research: Perceptual
foundations. International Journal of Market Research, 57(6), 837-854.
Barrett, A. K. (2018). Electronic health record (EHR) organizational change: explaining
resistance through profession, organizational experience, and EHR communication
quality. Health communication, 33(4), 496-506.
Brannen, J. (2017). Mixing methods: Qualitative and quantitative research. Routledge.
Bryman, A. (2017). Quantitative and qualitative research: further reflections on their
integration. In Mixing methods: Qualitative and quantitative research (pp. 57-78).
Routledge.
Creswell, J. W., & Creswell, J. D. (2017). Research design: Qualitative, quantitative, and
mixed methods approaches. Sage publications.
McCusker, K., & Gunaydin, S. (2015). Research using qualitative, quantitative or mixed
methods and choice based on the research. Perfusion, 30(7), 537-542.
Morse, J. M. (2016). Mixed method design: Principles and procedures. Routledge.
Noble, H., & Smith, J. (2015). Issues of validity and reliability in qualitative
research. Evidence-based nursing, 18(2), 34-35.
Patten, M. L., & Newhart, M. (2017). Understanding research methods: An overview of the
essentials. Routledge.
Watson, R. (2015). Quantitative research. Nursing Standard (2014+), 29(31), 44.