Electronic Health Records: Adoption & Barriers

This assignment examines the adoption and barriers related to Electronic Health Records (EHRs) within healthcare. It delves into various perspectives, including those of nurses, physicians, and healthcare information management systems professionals. The analysis considers both the advantages and disadvantages of EHRs, highlighting factors that hinder or facilitate their implementation. The provided resources encompass academic journals, online articles, and research studies that offer insights into the impact of technology on nursing care, change management strategies for EHR adoption, and the experiences of healthcare providers in navigating this transition.

DISSERTATION

EXECUTIVE SUMMARY
The given investigation is based the topic of impact of electronic health records (EHR) on
work efficiency of nurses in order analyse benefits of EHR at global level. It is necessary to
maintain information and preserve it in terms of increasing accuracy of decision making for
providing correct treatment to an individual. However, the present document is going to show
different barriers to apply electronic health records which create issues to set it in organisational
settings globally. Meanwhile, the barriers consist lack of resources, financial challenges,
confidentiality, security & data privacy, loss of access to medical records while computer
crashed or power fails, additional time required for data entry, complexity of technology, lack of
technical staff, problem with drug alert system and system hanging up problem. In addition to
this, it include various theories which are helpful to reduce such factors which generate problem
in terms of applying EHR in hospital settings at global level properly. Moreover, it involves the
improve efficiency and tasks effectiveness by efforts of staff members by making them
convinced through motivation. This investigation consist certain appropriate theories such as
human relation theory, classical management theory, system theory and neo- human relations
theory. Furthermore, these theories provide support to encourage employees for accepting new
technical system that is electronic health records which facilitate to improve their regular
productivity and results into increased outcomes.

Table of Contents
EXECUTIVE SUMMARY.............................................................................................................2
TITLE..............................................................................................................................................1
INTRODUCTION...........................................................................................................................1
Background.............................................................................................................................1
Rationale.................................................................................................................................2
Scope......................................................................................................................................2
Aims.......................................................................................................................................3
Objectives...............................................................................................................................3
Questions................................................................................................................................4
Theory.....................................................................................................................................4
Method of analysis.................................................................................................................4
Evidence.................................................................................................................................5
Relevance and feasibility of project.......................................................................................5
LITERATURE REVIEW................................................................................................................5
Analyse the improvement in work efficiency and task performance of nurses due to utilisation
of paperless documents...........................................................................................................5
Benefits of digital technology on nursing care.......................................................................7
Barriers faced by nurses due to adoption of electronic health records for maintaining desired
information.............................................................................................................................9
ANALYSIS....................................................................................................................................12
Types of investigation..........................................................................................................12
Research design....................................................................................................................13
Research approach................................................................................................................13
Research philosophy.............................................................................................................14
Data collection method.........................................................................................................14
Sampling Method.................................................................................................................15
Data Analysis........................................................................................................................15

Accessibility issues...............................................................................................................15
Ethical Issues........................................................................................................................16
Validity and reliability..........................................................................................................16
DISCUSSION................................................................................................................................16
Theory in Practice.................................................................................................................16
Comparative Analysis..........................................................................................................19
CONCLUSION..............................................................................................................................22
RECOMMENDATIONS...............................................................................................................23
REFERENCES..............................................................................................................................25

TITLE
“To determine the impact of electronic health records on work efficiency of nurses in
acute care.”
INTRODUCTION
Background
Electronic health records (EHR) can be described as a digital version of patient's chart
which can be easily maintained by nursing staff globally. It can be considered as real time and
patient centred records which can be used by authorised users instantly and securely. However, it
is beneficial to maintain information of sick individuals which can be used in future for further
treatment to make them healthy accordingly (Smolowitz and et. al., 2015). Moreover, EHR
provide support to contain history of patient, medications, diagnosis, dates of immunisation, plan
of treatments, radiology images, allergies and laboratory & test results. Meanwhile, it is also
helpful to allow access regarding evidence based tools which can be utilised by medical
professionals in order to make correct decision for providing appropriate care of patient. In
addition to this, the most effective benefit consist an automate and streamline to care providers in
respect of improving their workflow respectively. Furthermore, it is beneficial for nursing staff
to increase their working efficiency and facilitate to maintain overall records accurately. The
electronic health records is related with digital technology as it is an application of the same
which can be used to by nursing staff to maintain medical records of patients accurately for
future purposes regarding acute care in healthcare organisations at global context.
The nursing staff gain support from EHR in terms of managing their work in shortage of
nurses and it reduce the requirement of staff in context of making as well as maintaining
information about patients. The present report will focus on impact of electronic health records
on work efficiency of nurses in acute care (Moorhead and et. al., 2018). Meanwhile, the
electronic health records provide support to nurses for completing their tasks of providing
medications or diagnosis immediately which facilitate to reduce risk of complications in patients.
It will also include identification of different barriers of electronic health records for nursing staff
which create problems to implement the same in proper manner. However, the working
efficiency and tasks performance of nursing staff with the help of utilising paperless documents
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will described here. Moreover, there are several benefits of digital technology in context of
nursing care is given below.
Rationale
The study on impact of electronic health records on work efficiency of nurses in acute
health is essential to be carried out in order to improve overall performance level of nursing staff.
It is necessary to analyse the concept of EHR and evaluate that it is favourable to be applied for
nurses in acute care to increase effectiveness of their performance in context of improving
patient experiences respectively (Butcher and et. al., 2018). However, it is necessary to analyse
different advantages of EHR in order to gather specific evidence for adopting the same at work
place in organisations regrading acute care at international level. Moreover, EHRs has several
benefits such as improved patient care, increase patient participation, improve care coordination
among professionals, improved diagnosis with better patient outcomes and cost saving &
practice efficiencies accordingly. Meanwhile, it is significant to evaluate accuracy of electronic
health records which provide support to increase appropriateness in decision making for sick
individuals in order to make them disease free.
The investigation about electronic health records is important to analyse features of the
same in context of different various types of activities related to patients. It include to evaluate
the roles of EHR such as administrative & billing data, patient demographics, progress notes,
vital signs, medical histories, diagnoses, medications, dates of immunisation, allergies, radiology
images and lab & test results. Meanwhile, it is helpful to analyse the significance of utilising
EHR among nursing staff in respect of attending overall sick individuals properly and provide
accurate medications accordingly. However, this study is essential as it provide specific purpose
of adopting EHR in healthcare organisations at global context for improving performance of
nursing staff which facilitate to increase patient outcomes and perfection in clinical practices of
them (Brennan and Bakken, 2015). It is significant to evaluate the effectiveness of EHR in terms
of solving problem of shortage of nurses by fulfilling tasks of an individual by technological
system in appropriate manner.
Scope
The scope of investigation about given topic is broad as it can be accepted at large level
in context of evaluating potential benefits of using technology including electronic health
records. It is helpful to analyse the effectiveness of this system to ensure that it is much efficient
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in context of acute care then it can be implemented in different hospitals in order to improve
medication outcomes. Initially, the adoption of EHR is observed in number of healthcare
organisations in global levels in order to maintain their records along with improving working
efficiency of professionals. These systems can be utilised in individual organisations, as
interoperating systems in affiliated care units at regional and national level to improve
effectiveness of medical facilities as well as patients outcomes. In context of United Kingdom.
EHR adoption was driven by government regulations or financial stimulations which is
beneficial for hospitals to maintain their information with accuracy. It will facilitate to improve
quality and safety of patient care with the help of EHR adoption is priority area government and
policy makers in United kingdom. However, it will provide support to nurses and other
professionals to make accurate decision to provide appropriate treatment in terms of making
people diseases free properly. Moreover, the investigation on electronic health records will gain
surety about the benefits of this system which is helpful to solve problem of shortage in nursing
staff and increase patients outcomes in acute care in institutions. In addition to this, it will
generate an autonomy for nurses for gain improving in various areas as it helps to conduct
assessment, care plan & evaluation along with health teaching patients and families accordingly
(Nelson and Staggers, 2016). Meanwhile, it is significant to adopt in terms of increasing
effectiveness of communication and quality of care as it facilitate to make accurate decision by
nurses for welfare of people. Furthermore, it is beneficial in prevention & promotion of health,
improve management of staffing level and problem solving in proper manner.
Aims
“To determine the impact of electronic health records on work efficiency of nurses in
acute care.”
Objectives
 To analyse the improvement in work efficiency and task performance of nurses due to
utilisation of paperless documents.
 To evaluate the benefits of digital technology on nursing care.
 To determine the barriers faced by nurses due to adoption of electronic health records for
maintaining desired information.
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Questions
 How to analyse the improvement in work efficiency and task performance of nurses due
to utilisation of paperless documents?
 What are the benefits of digital technology on nursing care?
 What are the barriers faced by nurses due to adoption of electronic health records for
maintaining desired information?
Theory
The theory utilised to conduct investigation provide support to researcher in order to
create more appropriate ideas and concepts so that they complete research properly. It is
necessary to make correct decision for applying an effective as well as efficient theory for
carrying out overall research which helps to analyse authentic information and make accurate
results. However, the given investigation will prefer to conduct literature review in respect of
allying the theory in this project which facilitate to study relevant information and gain desired
outcomes respectively. The literature review can be explained as critical and in depth evaluation
of articles and other gathered data. Moreover, it can be considered as a summary and synopsis of
specific area of research to make accurate conclusions of investigation.
Method of analysis
The method of conducting research is very important to be selected in proper manner as it
provide support to gather desired information related to particular topic. It consist two types of
research i.e. qualitative and quantitative which has their own criteria of utilising information and
suitable for various investigations as per requirements (Nguyen, Bellucci and Nguyen, 2014).
However, the primary and secondary sources can be used to gather required amount of
information of studying about specific issue of research which helps to make more accurate
outcomes. Moreover, the the research design should be selected properly which is suitable for
specific investigation including descriptive, exploratory and experimental that is favourable for
particular topic of project. In addition to this, the research philosophies include positivism and
interpretivism from which one them can be adopted for conducting research and gain appropriate
results.
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Evidence
The information system in healthcare organisation plays an important role by maintaining
overall records of data regarding patients and other aspects of administration. It is essential to
gather desired information as per requirements and refer data for future purposes to provide
accurate medications for sick people. In context of preparing appropriate records, the electronic
health records system is beneficial for healthcare organisations in order to make records of
information and preserve them for further aspects regarding sick individuals to make immediate
decisions respectively (Stalpers and et. al., 2015). Moreover, it is helpful for healthcare
organisations to manage their work in case of shortage of nursing staff and improve accuracy
medications for making patient disease free at international level.
Relevance and feasibility of project
The project is highly relevant to topic as it is helpful to improve performance of nursing
staff in terms of completing their medical tasks accordingly thorough gaining better outcomes.
The given investigation provide support to ensure about benefits of this system in terms of
improving accuracy of decision for making people healthy. However, this research facilitate to
analyse the effects of using digital technology in healthcare in respect of increasing patient
outcomes as well as reduce risk of complications regarding acute care. It is helpful for nursing
staff to manage their work during shortage of nursing staff and avoid chance of mistakes or
problems while conducting their work.
LITERATURE REVIEW
Analyse the improvement in work efficiency and task performance of nurses due to utilisation of
paperless documents
The paperless documents refers to electronic clinical document which can be used by
nursing staff to make decision about patients in order to provide correct medication to them at
right time. It consist various types of digital applications which can utilised like electronic health
records to maintain information for future purposes globally. However, the paperless documents
can be easily communicated with other colleagues within few seconds which save time of
professionals ans they can performance their task more effectively. In addition to this, it is
helpful for hospital staff to increase for accuracy of transferred information between team of
professionals which impacts positively on decision making of medication and experience of
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patient. As per view point of Sarah Payne (2013), there are various improvement can be achieved
by nursing staff in terms of managing their work and increase patient experience. It will facilitate
to improve accuracy of information and speed up work so that professionals become more
efficient in respect of boosting up their performance in healthcare at international context.
Improve accuracy – The paperless documents can easily transfer to associated
professionals in order to convey same information to them in accurate manner which impacts on
decision making positively. It involve to convey accurate data related to medical records of
particular patient and evaluated progress by providing medication in terms of making them
disease free globally. Moreover, the digital technology provide support to medical professionals
and communicate with each other by sitting in their departments and clear doubts within seconds
rather than visiting other section to discuss regarding specific client.
Increase quality of services – The electronic record system is helpful to reduce chance
of mistakes in medications which facilitate to improve treatment process in terms of increasing
quality of healthcare services in global context. As per views of Yanhong Qin (2017), it is
important to make an appropriate procedure of medication as per diagnosed disease of patient in
respect of improving effectiveness of treatment which results into better patient outcomes. Paper
less work helps to save time which facilitate to increase focus of nurses towards each person and
provide medication on time to make them disease free very soon.
Maintenance of records – This can be described about medical information of various
patients and other administrative aspects in electronic health records which facilitate to gain easy
access of desired data on time. It is necessary to maintain information and records for a long time
in order to fulfil future purposes as they are helpful for further medications as well as deal with
unconscious patients properly. Electronic health record system is helpful to avoid extra staff for
making only records of information which helps to solve problem of shortage of nurses globally.
Reduce burden of work – The problems of nurses can reduce their pressure of work as
they can save time of visiting different departments for certain discussion regarding patients and
manage their work in proper manner. As mentioned by Leila Vali, (2015), they can communicate
every detail with colleagues or superiors and gain sufficient time to complete their overall tasks
properly through reducing burden of work.
Manage shortage of nursing staff – This can be described as to make an appropriate
schedule of working due to shortage of working by adopting digital technology by setting
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electronic health records which helps to reduce need of extra staff. It will facilitate to avoid
confusion and easily make available the desired information to nursing staff through which they
can mange their tasks properly. However, the problem of shortage of staff can be solved by
conducting overall procedures by managing with the help of EHR to complete work on time at
international level.
There are various theories which can be applied for motivating employees in hospital in
context of accepting electronic health records easily in global context. It involves several
effective theories such as human relation theory, classical management theory, system theory and
neo- human relations theory which facilitate to make people for accepting new technology in
appropriate in order to gain desired benefits from the same. However, it is essential to apply
these theories which encourage staff members to utilise electronic health records in more
effective as well as efficient manner in respect of attaining better outcomes from given technical
record system.
Benefits of digital technology on nursing care
The digital technology can be described as overall electronic equipments and applications
which can be use to store and transfer information properly. It is helpful in different sectors
including healthcare in which professionals can manage their work in proper manner through
conducting effective procedures and practices for welfare of patients globally. However, it is
important to implement applications and software which provide support to store and process
data as per requirement in order to make correct decision to make sick individual disease free. As
per views of Geneviève Rouleau (2015), utilisation of digital technology is beneficial for nursing
care as it provides support to make accurate decisions by evaluating correct diagnosis of patient
for making them healthy. Thus, there are different benefits which can be achieved in nursing care
implementing digital technology in which few of them are as under –
Availability of Information and big data – This can be described as to gather and store
large amount of information related to patients and other administrative activities in hospitals
which can preserve by single system. It is helpful to make gain required information from same
server which reduce confusion and save time of searching data in order process further activities
in global context. However, digital technology facilitate to connect people online in order to
communicate information to each other for betterment of nursing care practices which results
into improved patients outcomes and perfection in clinical procedures. Additionally, it provide
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different benefits such as reducing healthcare cost, predicting epidemics, avoiding preventable
deaths, improving quality of life, reducing healthcare wastage, improving efficiency & quality of
care and development of new drugs & treatments.
Improved communication – The communication become more effective as well as
efficient in by adopting various communication system including information & communication
technology. According to the opinion given by Siv Rauv (2018), it also include optical, tactical,
half- duplex, radio and duplex communication system. However, effective and accurate
conversation is very important because single misconception may create severe problem in
medication so that correct data is required to be proceed to conduct appropriate treatment to fulfil
patient desires. Additionally, electronic medical records can be accessed by associated care
providers and departments which facilitate improvement in case management, treatments and
patient recovery at international level.
Electronic Medical Records – Previously, information records of patients were
maintained separately by related department like dentists, general practitioners, specialist and
allied health professionals. However, electronic medical records are helpful to store information
on same server from where required information can be selected for decision making regarding
treatment of sick people globally. It consist different types of information related to patient
histories, test results, diagnosis and other relevant information which is stored at centrally online
location to facilitate easy access to desired data.
Telemedicine/Telehealth – The telemedicine or telehealth can be explained as a two-
way consultations and transmission of healthcare data including CT Scans, ECGs, sonography
etc. It involve the criteria to exchange information online and provide reports from the same
medium in global context. However, it is helpful to those specialist who were far away from
patient so that they can easily get access to required data and provide desired prescription to
them. Additionally, nursing staff can provide face- to- face clinical services sick individual at the
time of teleconsultation along with ensuring the appropriateness of procedures respectively.
Apart from this, nursing staff can easily improve their knowledge levels and skills through online
learning programs for improving their practices. Furthermore, telemedicine is beneficial as it
reduce waiting time of patients, improve access to rural people and increase efficiency leads to
savings.
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Mobility and Mobile Apps – This refers to mhealth i.e., mobile health in which various
applications can be used by professionals and services users to communicate with each other and
transfers required information as well. As mentioned by BIANCA BANOVA (2015), these apps
are helpful in various healthcare areas including management of medication, chronic care,
medical reference, diagnostics, personal health records, fitness & weight loss and mental health.
Moreover, specialist can access EHR of patient and then study overall medical history in order to
send complete prescriptions to them for their welfare immediately at global standards.
Enhanced Patient Care – The digital technology is very supportive to healthcare
professionals as EHR system can automatically send an alert regarding potential issues including
allergies or intolerance of specific medicines globally. However, it will provide support to
physician to gather previous medical records of patients specially in case when patient is
unconscious then such data is helpful to make accurate decision to give proper medication
accordingly.
Improved Public Health – The digital technology including EHR plays an important
role in context of boosting up public health. EHR provide invaluable data to medical researchers
which facilitate to implement appropriate modifications in clinical practices and develop fresh
procedure of treatments for common health problems at international level. Additionally, digital
tools are helpful for nursing staff in order to determine any viral or bacterial infection
immediately to take quick actions for reducing complications and make patients well-being.
Ease of Workflow – This can be described as working and conducting tasks by medical
professionals easily and effectively by managing regular clinical practices accurately with the
help of digital tool like EHR. The electronic health records provide support to nursing staff in
terms of managing their work due to shortage of nurses and properly attend every patients by
giving accurate medication to them on time in global context. Furthermore, it is helpful to save
time of gathering required data and communicate information to specialist or other associated
professionals in respect of providing immediate and accurate treatment to an individual.
Barriers faced by nurses due to adoption of electronic health records for maintaining desired
information
Electronic health records (EHR) can be described as a technical system which provide
support to make systematised collection of patient information in digital format globally. These
records are helpful to manage overall data of patient relevant to their medication, diagnosis and
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other administrative knowledge for future purposes in terms of improving decision making for
providing correct treatment accordingly. However, EHR is helpful top nursing staff for managing
records of sick people in order to give desired medication and evaluating progress of provided
treatment respectively. According to the views of Clemens Scott Kruse (2016), there are various
kinds of barriers to electronic health records which create problem for adopting the system
among nursing staff. Thus, there are various barriers in which some of theme are explained
further –
Lack of resources – The resources are main factor which is primarily required to be
adopted new technique of system in organisations at international level. It include the various
types of resources such raw material, staff members, money, assets and many mote which are
required to be implemented EHR in hospital for maintaining records of patients properly.
However, it is necessary to utilise desired amount of resources which provide support to set EHR
appropriately in order to improve management of information regarding sick individuals for
increasing their experience.
Financial challenges – The funds are very important to which are required to be
arranged in sufficient amount in order to make several changes or modifications in hospitals for
attaining improvements respectively. As per opinion of Azza El. Mahalli (2015), Electronic
health records is a kind of technical system which requires enough funds to make set up the same
for gaining desired benefits from it. However, the management and repairing or this system will
be expensive in future then it is difficult to manage it in future. Moreover, it is necessary for
authorised people of hospital to ensure about the management and repairing of electronic health
records to gain desired benefits in global context.
Confidentiality, Security and data privacy – The electronic health records has a criteria
to make records of everything in hospital like patient medical information and other
administrative data on particular system. On the basis of views provided by Sima Ajami (2013),
However, employees working in organisation can easily gain access to any type of information
which create problems regarding privacy and confidentiality of information at international
standards. Moreover, it is necessary to management of hospital to take care of security and
privacy of information related to sick individuals and company administration which may create
problem in future.
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Loss of access to medical records while computer crashed or power fails – The
technical system are very effective as well as efficient to maintain records and speed up the work
but a single problem may responsible for occurring huge problem. There are various technical
faults which may corrupt overall data due to crashed computer that will results into loss of
information and it will create problem in healthcare organisation to make further decisions for
patients and other administrative procedures. It will impact negatively on performance of
professionals and consumes more duration of time because they have to conduct overall test and
lab activities to analyse problem to provide medication globally.
Additional time required for data entry – This can be described as duration of time
consumed to make entries in electronic health record system which is also a barrier because time
is really valued in healthcare. A single second may create complications if not entertained on
time which is required to be focussed in order to attend patients properly at international level. It
is necessary to make proper schedule of managing time for conducting data entry in electronic
health records by nursing staff so that they can perform their work effectively along with
maintaining information in proper way.
Complexity of technology – The technological applications are helpful to conduct
overall operational activities and maintenance of information for future aspects along with
ensuring privacy of the same. As mentioned by Arab-Chadegani (2013), it consist complexity in
digital system like electronic health records which is not easy to be used by employees and
required technical staff for further support. It is essential for nursing staff to learn the utilisation
of EHR in proper manner which facilitate to gain desired benefits of the same in their
performance regularly in global context.
Lack of technical staff – The technical staff is mandatory in hospital in order manage
technological equipments, applications, software and machines so that minor problems can be
easily solved on daily basis. It is important to hire technical employees so that minor faults of
regular basis to sort out easily which facilitate to utilise EHR effectively and gain better results in
terms of increasing perfection in clinical practical practices at international standards. Moreover,
technical staff can deal with every technology problem and make nursing staff learn about use
electronic health records system effectively.
Problem with drug alert system – The drug alert system is helpful to provide signal
about medications regarding patients which get disturbed if overall information can be managed
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by single system of EHR in hospital. It include the problem on drug alert which is helpful to
make nurses active at right time in respect of providing medications to sick individual properly.
Moreover, it is essential to mange drug alert because it is mandatory to attend patients in desired
time for giving required drug or treatment to make them disease free in global context.
System hanging up problem – The technological systems has major problem that they
will get hang which create problem in working and consumes much time. It consist issue getting
hang due to bulk of data which cannot be processed for need till the hanging of software cannot
be solved globally. The problem of hanging up of systems create barriers for adopting electronic
health records because it will generate problem for gathering required information about patients
in emergency situation in respect of making decision to give needed medication.
The above barriers are required to be removed by applying effective models, approaches
and theories in order to apply electronic record system globally in proper manner. There are
various theories which can applied in hospital such as Theory of Reasoned Action, Theory of
Planned Behaviour, Technology Acceptance Model and Actor network theory. Initially, theory
based action is helpful to assume future response of people based on pre- existing behaviour &
attitude which facilitate to make new strategy to successfully applying electronic record system.
Secondly, Theory of Planned Behaviour refers to analyse beliefs and behaviour of workers which
helps adopt electronic system as per their preference through reducing barriers. Moreover,
Technology acceptance model and Actor network model are supportive to remove barriers of
electronic record system.
ANALYSIS
Types of investigation
The investigation consist tow types such as qualitative and quantitative research from
which researcher is required to select the more suitable one to conduct the overall research
properly. It is essential choose correct method of investigation according to particular topic ad it
impacts on whole research. However, qualitative research is suitable for exploratory
investigation in which investigator gain deep understanding about experiences, thoughts,
opinions and trends in order to make accurate outcomes (Weaver and et. al., 2016). At the other
hand, quantitative methods contains numeric values, facts and figures to be analysed about
specific topic. It involve to quantify attitudes, opinions, behaviours and other defined variables
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regarding specific objective and generalise result from study sample to general population. The
present report will prefer to utilise qualitative research in order to analyse given problem to make
appropriate outputs respectively. It will facilitate to conduct activities like focus groups,
interviews and review the documents to analyse effects of EHR on performance of nurse.
Research design
The research design can be described as an appropriate framework of technique and
methods which is selected by investigator in terns of combining components of research to make
desired results. It include the various types of methods which are helpful to gain better outcomes
in different kinds of research program accordingly. However, it include descriptive, exploratory
and experiments research design from which investigator can select one which is more
favourable to conduct investigation in specific topic. Moreover, descriptive design can be
described as depth description of collected data which is mostly observational in nature.
Additionally, exploratory method refers to criteria of exploring new model or idea in respect
making the investigation more effective (Forbes and Watt, 2015). At the other hand,
experimental research based in number of experiments and mathematical analysis with particular
theory or law. The given investigation will prefer to utilise descriptive research design which is
helpful to give proper detailed explanation about impacts of EHR on work efficiency of nursing
staff.
Research approach
It is the technique through which indicates how the research has been done by the
researcher. It is the plan or the procedure that a researcher applies which consist of steps of broad
assumptions to the detailed method of collection, analysing and interpreting the data. This
consist of different types of approaches which includes the inductive and deductive that could be
adopted by researcher so that the research can be done in a better way. As it is seen that
deductive approach is considered as top down method which consist of several theories and
hypothesis which would support gathering of data and analysis of this. However this also consist
of the pattern that start with the theory then proceeds to hypothesis which is then believed to
confirmation (Collen and Ball, 2015). On the other hand inductive approach is described as the
bottom up approach that is used with the research questions and is also used as a collection
empirical data which is used to create a hypothesis on the research. As the present report is based
on inductive approach of gathering the data which start from questions in order to collect
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required data related to effects of EHR in performance of nurses for conducting investigation
properly. This approach is much effective than to conduct study about electronic health records
for improving performance in healthcare sector.
Research philosophy
It is considered as the belief about the way in which the data would be collected about the
specific topic. This is the research philosophy which deals with the nature, source and the
development of the information. As it is seen that the research philosophy consist of two types
which consist of positivism and interpretivism. The term positivism is considered as the tool that
can be used to collect a large number of sample which consist of quantitative information for
measurement (Urden, Stacy and Lough, 2017). However the term interpretivism is a philosophy
that is used to collect the sample which is small in size which would further help in creating a
detailed study. As it is seen that the given research is based on the interpretivisim philosophy that
is used to properly study the information which is desired for making a accurate conclusion for
the same. In addition to this, the technique of interpretivism can be considered as suitable for
collecting the information about impacts of electronic health records on working efficiency of
nurses in hospitals.
Data collection method
Information that is gathered by the researcher may come from different sources. It is the
process of collecting information from all the sources which are relevant for the current issue
that has been descried in the research (Black, 2016). These are analysed to find the answers of
research problems and to test the hypothesis and to evaluate the outcomes of it. These data
collection methods can be divided into two categories which consist of primary method of
collecting data and secondary method of collection data. The primary data collection method is
considered as the first hand data which is gathered by the researcher which consist of several
methods such as questionnaire, personal interview, observation and many more. This is
considered as the long term process and is also expensive. Also it is considered as specific to the
actual requirement of particular research that is being done. On the other hand a secondary data
collection method is considered as using of information which is already being collected by other
users such as government, websites users, books and journal users etc. The present research is
based on the primary data collection by taking views from nursing staff and other related
professionals in order to evaluate the effects of using EHR on task performance of nursing staff.
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Sampling Method
This is the method that is used as a statistical procedure which helps in selecting phew
participants from a number of population on the basis of which the conclusion would be made.
There are basically two different types of sampling which is present, one consist of random
sampling and other is non random sampling (Dougherty and Lister, 2015). The random sampling
consist of simple and stratified sample data which is taken for making any conclusion. While on
the other hand non random sampling includes the gathering of data on the basis of judgement,
quota and convenience sampling. It can be investigated as per the research topic and the
sampling of data can be done easily. In the present research the method that is used is random
sampling. Also the sample size for the given investigation is taken randomly i.e. 30 respondents
to gain desired information about effects faced by nurse due to utilisation of electronic health
records.
Data Analysis
The data analysis can be described as a process of inspecting, transforming, cleaning and
modelling of data with an objective of discovering useful information respectively. It include
analysis of collected information thoroughly in order to interpret appropriate findings in proper
manner. However, it consist criteria of collecting data from various sources including journals,
books, articles and websites to gain correct observations (Simpao and et. al., 2014). It include to
observe and analyse desired information and discuss findings in proper manner. The given report
will prefer to critically evaluate theories discussed in literature review along with findings of
investigation regarding impacts of using EHR performance of nursing staff. It is helpful to
analyse the comparison between suitable theories in order to make appropriate conclusions.
Accessibility issues
This is the issue which arise while capturing the information from the different sources.
Also it is important for them to get the legal permission to handle the data that they have. It is
necessary for them to gain the legal permission and should follow the ethics while having the
data. The researcher should take a approval from an individual whose data he is using. The
information which is collected should be reliable and should contain accurate results
accordingly. In addition to this, it is essential for them to put sufficient amount of funds and
accurate duration of time in order to analyse appropriate information about effects of using EHR
in working efficiency of nurses in hospitals.
15

Ethical Issues
There are several ethical norms which is necessary to be followed by researcher while
carrying out specific aspect accordingly. It is essential to follow ethical value such as minimising
risk of injury, obtaining informed permission, protecting obscurity & confidentiality, avoiding
deceptive practices and furnishing right to withdraw. However, researcher is needed to make
sure that any activity will not harm participants (Lin and et. al., 2014). The investigator is
required to render right to participants in order to withdraw from engagement due to authentic
reasons respectively. At the other hand, it is important for investigator to conduct every activity
of inquiry by following legal rules and other ethical principles suitably. The present research has
been follow overall ethical principles while gathering data about benefits of EHR and maintain
confidentiality, privacy & take legal permission or using specific data. However, researcher has
spend proper duration of time and cost to gain overall data and analyse the same to gain accurae
findings.
Validity and reliability
The researcher is required to focus on validity and reliability of results make has been
made by conducting analysis of information on overall research. It is necessary to make sure that
information gathered by researchers is reliable or not because it plays an important to role for
making conclusions accordingly. Moreover, it is analysed that research will considered as valid
if it provide reliable outcomes that can be used in future ass well. Furthermore, the researcher
must put proper efforts and duration of time for gathering authentic information which is helpful
to make study reliable and valid respectively (Matziou and et. al., 2014). The given investigation
is reliable because it utilise primary sources of data collection by conducting interviews of
selected respondents to gather practically appropriate information about effects of EHR in
performance of nurses.
DISCUSSION
Theory in Practice
It has been discussed that electronic health records are essential to be maintained as it
impacts on decision making medication in order to make an individual well-being. It include to
make an accurate record of every patient by mentioning each detail related to medication,
diagnosis etc. However, it is necessary to maintain other administrative records of information
16

which can be used for future purposes (Weis and Levy, 2014). There are several barriers take
place in adoption of electronic health records which is helpful to maintain accuracy and easily
find out data about particular patient which facilitate to save time of staff and they attend every
sick individual properly. Moreover, it is necessary to apply the electronic health records by
adopting more effective as well as efficient theories so that workers can easily accept the same
without showing resistance towards new system. In addition to this, it is necessary to analyse
behaviour and attitudes of staff members and then make appropriate strategy to apply electronic
health records so that people will easily adopt the same.
On the other hand, it has been analysed that management of healthcare organisation can
be adopt appropriate theories to make people easily accept the implemented electronic health
records. Initially, the Theory of Reasoned Action (TRA) states that intension of an individual to
perform a behaviour or not can be considered as an immediate determinant of that particular
action. It consist the concept that behaviours can be determined by intension whereas intentions
explains attitudes & subjective norms and both of them described in terms of beliefs
(Ignatavicius and Workman, 2015). This theory provide support to predict behaviours of
employees before applying new electronic system through desired strategy to make people
convinced for adopting new technique of maintaining records properly. Secondly, the Theory of
Planned Behaviour (TPB) can be described as a concept to predict intension of an individual to
engaging them in particular behaviour at specific time and place. It can be considered as similar
to Theory of Reasoned Action for prediction of behaviour and attitudes in order to exert self
control. However, it include the major components as behaviour intension which facilitate to
assume expected outcomes for particular action (Mealer and et. al., 2014). In addition to this, it
actually states that behavioural achievements depends upon both motivation (intension) and
ability (behavioural control). It is observed that Theory of Planned Behaviour is more
appropriate to be adopted in terms of implementing electronic health records at work place in
healthcare organisations. This model is helpful to distinguish among behavioural, normative and
control which are helpful to apply fresh technical system at work place in hospital.
Thirdly, the Technology Acceptance Model (TAM) can be explained as a process
including perceived usefulness, ease of use, intension to utilise and usage behaviour of people. It
is helpful to people as it provides valid and reliable measure which assume an acceptance or
adoption of new technologies by end users accordingly. However, it can be used in healthcare
17

organisation to implement an appropriate electronic records system which ensures accuracy of
patient information and data of other administrative activities that can be utilised in future. It
consist the criteria to make employees believe that upcoming new technological system will
helpful to increase their performance on regular basis (Mason, Nicolay and Darzi, 2015).
Meanwhile, this theory include clear concept of making users known about way to use and
related which motivate them to accept specific technical system easily. In addition to this, it
involve to make an accurate strategy to make people known about using particular technology by
carrying out effective training and learning sessions so that they can easily utilise electronic
health records. It is necessary to conduct effective learning program to make staff capable for
utilising electronic health records and convey overall benefits of the same which motivate them
to accept new technical system properly.
At the other hand, Actor network theory can be described as controversial social theory.
It can be considered as a conceptual tool for investigation information systems with the help of
graphical format which is more supportive to gain information about desired benefits of specific
new technique. This theory can be described as a framework and systematic way for considering
infrastructure surroundings in order to achieve technological changes in organisation. It include
the criteria to analyse overall organisational structure and kind of staff members with their skill
or abilities in terms of implementing new technical system. The infrastructure of hospital and
capabilities of professionals are required to be evaluated and then apply electronic health records
successfully which facilitate to make staff convinced for adopting new technology.
At the other hand, the use of paperless documents by adopting electronic health records
are helpful for boosting up productivity and efficiency of medical professionals at work place. It
has been analysed that there are various theories which can motivate employees to accept new
technological system for maintain records of information in proper manner. Initially, Human
Relation Theory refers to focus on leadership, group motivation and inspiration in order to
manage relation between superior & sub- ordinate for cooperating each other to adopt electronic
health records. It will facilitate to improve their efficiency and regular productivity which
facilitate increase patient outcomes. In addition to this, Classical management theory can be
defined as to direct efforts of people towards set targets and goals in order to achieve them. It is
required to consider certain factors such as mark on structure, strict about what is upright in
organisation and manage practically. This model states that proper management should be done
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to implement new techniques like electronic health records and give effective definition of
management. It consist that management can be explained as to command, organise, forecast,
plan, control and coordinate which can be used to apply new method in appropriate manner. It
involve certain effective concepts scalar chain, centralisation, division of labour and unity of
command which can be used at work place so that tasks can be managed properly after applying
electronic health records (Bryant and Nix, 2015).
In addition to this, system theories can be described as to make focus on particular system
of working which facilitate to make an accurate records of information. It include interconnected
sub- system which are helpful to apply new technical system for maintaining medical
information related to patients which facilitate to boost up efficiency of staff in respect of
achieving better outcomes of medications. However, it consist a specific system to be adopted by
employees in terms of managing all the tasks in proper way at the time of implementing
electronic health records to gain maximum outputs respectively. It consist specific system build
by efforts of synthesise with classical and human relation approaches which focus on social and
psychological which highlight the needs of people (Doenges, Moorhouse and Murr, 2016). It has
several key terms like boundary, subsystem, focal system, open-system, supra-system and
closed-system. The Neo human relation theory can be explained as a group complex theories
given by different psychologist in order to analyse actual needs of an individual and motivate
them accordingly. For example, Maslow theory include needs of human beings such as self-
actualisation, esteem, love & belonging, safety and physiological requirements. The management
of hospital can focus on these factors to encourage staff for adopting new electronic health
records easily by making them believe to gain better outcomes for their growth and success
through improving their work efficiency. The particular concentration involve incentive,
satisfaction and intrinsic which are very effective to encourage an employee for accepting fresh
records system in healthcare organisation to increase their regular productivity (Duffield and et.
al., 2014).
Comparative Analysis
It has been observed that Theory of Reasoned Action is much effective as compared to
others in order to predict to predict behaviour and attitudes of staff in accurate manner as this
model is very effective for prediction behaviour under volition control at work place in
healthcare organisation. Meanwhile, it has several limitations that there are not enough
19

longitudinal studies on TRA resulting in an over reliance on cross sectional study. This theory
deals with solely with behaviour under volitional control and it will not consider
interrelationships among variables. Furthermore, the Theory of Reasoned Action can be
considered as an obsolete because of Theory of Planned Behaviour accordingly. It is found that
his theory is only applicable in few of conditions and healthcare organisation can adopt this
model as per suitability of specific situation. Thus, the implementation of electronic health
records can be done by applying TRA by predicting behaviour of employees by applying new
policy in proper manner. It is analysed that Theory of Planned Behaviour can be applied in
specific situation in which it is suitable in respect of implementing electronic health records.
However, it has several strengths and weaknesses due to which it is applicable in particular
condition in an organisation.
In contrary to this, it has been evaluated that TBP is applicable for assuming an
individual has acquired opportunities and resources to be successful in order to perform desired
behaviour, regardless of intention. Meanwhile, it does not account for another variables that
components into behavioural intension as well as encouragement including fear, mood, threat or
past experience. Basically, it will not prefer to environmental or economic factors into account
while considering normative influences which may impacts on intention of a person to perform
specific behaviour (Li and et. al., 2014). It is observed that, this theory is suitable for predicting a
behaviour which is an outcome of linear decision making process and does consider that it can
change over time. Furthermore, addition of construct of perceived behavioural control is
considered as an important add on to theory as it cannot state anything about actual control over
behaviour. At last but not the least, it is possible to address the frame between intent and
behavioural action by this theory.
Moreover, TAM is helpful to accomplish tasks more quickly as compared to other
theories and facilitate to increase productivity, improve effectiveness of performance and make
easy for employees to conduct overall clinical practices in correct manner. In contrary to this,
this model is based on convincing people for adopting new technique by making them aware to
utilise it and related benefits but it is limited in case of rigid people. It has been evaluated that
there are few individuals who become rigid and it is difficult to make them convince through
motivating towards profits gained by TAM but then required to adopt another appropriate
strategy to apply electronic health records at work place in healthcare organisation (Adam,
20

Osborne and Welch, 2017). The Actor network theory is much efficient rather than other theories
as it will provide support to employees for increasing their work efficiency and attend every
patient properly which helps to reduce mistakes in medications respectively (James, Nelson and
Ashwill, 2014). The strength of this theory is that it is suitable according to organisational
structure and abilities of staff members which can be easily accepted by medical professionals in
order to improve their performance. It is helpful to increase efficiency of people and desired
outcomes by reducing chance of occurring mistakes in healthcare organisation. Moreover, there
are several barrier to electronic health records related to policies of organisation and skills of
staff members which can analysed by this theory in respect of implementing desired technology
in correct manner. It will provide help to accept given technical system for improving accuracy
or records which facilitate to increase effectiveness of outcomes in healthcare organisations.
On the other hand, the human relation theory has a motive to drive work force towards
correct direction in terms of utilising given technical system effectively which results into
gaining maximum outcomes of the same (Lilly and et. al., 2014). It is more effective than other
models to direct efforts of people in correct direction for achieving desired goals with better
outcomes. According to this model, it has been evaluated that workers are descriptive and
endeavoured to be predictive of behaviour in healthcare organisation. It consist to select
appropriate method for achieving set goals and objectives of increase work efficiency of staff
within hospital by implementing electronic health records. The strength of this theory is to
encourage professionals for accepting new technical system but it has a limitation in case of few
individuals who are rigid and create employee resistance towards fresh technological method for
maintaining records. In contrary to this, the classical management theory include the criteria to
consider several key points including discipline, division of work, unity of direction &
command, division of work and order. However, this theory is more effective than other models
to manage the above mentioned key aspects as it has strength of conducting everything with
discipline which is helpful to motivate people by managing work with new technique. It will
facilitate to mange overall work with new technical system and encourage people to adopt the
same properly in hospital. Moreover, it has a limitation that it consumes more time for allocating
right task to right person for by re-scheduling in proper manner.
Comparatively, the system theory is helpful to employees as it reduce confusion and
concentrate on single criteria to perform their respective task in hospital. In contrary to this, it
21

has a limitation that single system may not be applicable in every situation then it will create
problem to deal with present issue related to work and reduce efficiency of staff members at
healthcare organisation. In contrary to this, Neo human relation theory is much efficient to help
the managers in order to analyse and understand the actual needs of an individual and out efforts
to fulfil them so that they will easily follow order of their superior in context of adopting
electronic health records. It is analysed that neo human relation theory is much effective to make
people convinced for accepting new technique which facilitate attain maximum of the same.
Consequently, it only focus on needs of employees but not on set goals and objectives of an
organisation.
CONCLUSION
With the help of above mentioned report, it is being concluded that electronic health
records would help nurses in improving overall performance level. Paper records were hard to
handle and would not been able to kept over there for a longer time frame. Medical records
carried in electronic systems may aid in analysing and keeping it for a long period of time. It is
essential to maintain accurate records medical information of patients and other administrative
aspects as it is beneficial for future purposes. However, in context of sick individuals, their
previous information provide support to make appropriate decision about medication in situation
when they are unconscious. It consist care plan and management techniques which provide
support to make improved care planning regarding welfare of people by carrying out correct
treatment. In addition to this, electronic health records provide support to communicate desired
information to associated medical professionals about specific person can be dome in single step.
It will facilitate to save time and increase accuracy of communicated data which results into
betterment treatment process. Along with this, motivation can also be given to staff as work on
them will directly reduce and hospitals may also improve accuracy of information. It also may
aid in increasing the working efficiency of medical professionals. At the other hand, employees
can be encourage by implementing new record system in healthcare organisation in improve
efficiency of working and perform regular activities to maintain data in proper manner.
Moreover, Electronic health records are helpful to reduce risks of occurring drug errors and other
related mistakes which facilitate to improve patient outcomes respectively.
It has been summarise that there are various kinds of barriers in terms of applying
electronic health records which are required to be removed for adopting the same. It involve
22

various factors such as lack of resources, financial challenges, confidentiality, security & data
privacy, loss of access to medical records while computer crashed or power fails, additional time
required for data entry, complexity of technology, lack of technical staff, problem with drug alert
system and system hanging up problem. However, these components creating barriers to
electronic health records can be sort by utilising several more effective as well as efficient
theories in respect of implementing the new technical system of information in correct way.
Moreover, it consist certain models including Theory of Reasoned Action, Theory of Planned
Behaviour, Technology Acceptance Model and Actor network theory which can be applied in
hospital to remove challenges to electronic health records. It is evaluated that given technique to
maintain information records in healthcare are helpful to professionals for boosting up their
working efficiency and performance at the time of carrying out different tasks at workplace.
Meanwhile, improve accuracy of information will facilitate to reduce chance of occurring
mistakes in medications as well as decrease complicated situations regarding health of sick
people in hospitals. There are several theories which can be used to make employees convinced
to adopt new technique for maintaining information in hospitals like human relation- theory,
classical management- theory, system- theory and neo- human relations theory. Furthermore,
there are various types of benefits which can be achieved by effectively adopting method of
electronic health records by employees as well as organisation to gain better outcomes
respectively. It consist various profits including availability of information & big data, improved
communication, electronic medical records, telemedicine/telehealth, mobility & mobile apps,
enhanced patient care, improved public health and ease of workflow. It is necessary to apply
electronic health records method in appropriate way in respect of achieving its maximum
outcomes.
RECOMMENDATIONS
From the above investigation, it has been recommended that every healthcare
organisation is required to adopt new and innovative technical system preserving desired records
in proper manner. It include to conduct maintenance of overall data which provide support to
improve effectiveness of care plan and increase patient outcomes. However, it consist to make an
appropriate documentation which facilitate to make correct decision to provide medication while
an individual become unconscious. In addition to this, it is suggested that electronic health
records is beneficial system which should be accepted by hospitals as it facilitate to improve
23

efficiency of staff members and increase medication outcomes on daily basis. Moreover, it is
recommended that effective technical system is needed to be adopted in healthcare organisation
by evaluating related barriers in order to sort out them properly. It will facilitate to gain optimum
output from new implemented technology which is favourable for employees as well as patients.
There are various types of technological equipments, machines, software and applications are
invented which are helpful for healthcare sector in terms of dealing with emergency situations
and improve outcomes of medical facilities. Meanwhile, it include to improve accurate
conversation among team of professionals connected with same case of patient to provide correct
treatment to make them well-being.
At the other hand, it has been recommended that management of hospitals is required to
apply various theories before applying electronic health records to remove relevant barriers in
proper way. It consist to utilise Theory of Reasoned Action, Theory of Planned Behaviour,
Technology Acceptance Model and Actor network theory which provide help to sort out number
of issues to implement fresh technology at work place. It is necessary to motivate employees by
more effective as well as efficient strategies in order to remove problem of employees resistance
along with them convinced to accept new technique appropriately. In addition to this, it consist
to make an accurate documentation of information related to patients and other administrative
activities which are helpful to fulfil future purposes. It is suggested that technical support is
beneficial to improve regular productivity as well as profitability through increasing goodwill
among customers and government bodies. Furthermore, healthcare organisations should adopt
new techniques by motivating their employees in respect of achieving growth and success.
24

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