1 ADVANCED PRACTICE NURSES MEANINGFUL USE OF ELECTRONIC HEALTH RECORDS
2 ACKNOWLEDGMENT This study was supported by a research grant from the University of Arkansas, College of Education and Health Professions
3 AUTHORS Bill Buron Thomas Kippenbrock Marie-Rachelle Narcisse Ellen Odell
4 PUBLISHED Applied Nursing Research
5 THE LAW The Health Information Technology for Economic and Clinical Health Act (HITECH) was enacted on February 2009
6 OUTCOME OF THE LAW Financial incentives for demonstrating meaningful use of electronic health records Eligible professionals and critical access hospitals must be participants in the Medicare and Medicaid programs and must adopt and successfully demonstrate meaningful use of certified EHR technology.
7 INCENTIVES Between January 2011-May 2012 (Stage 1), Medicare and Medicaid provided incentives payments of $458,983,387 to Arkansas, Louisiana, Mississippi, Tennessee to encourage EHRs utilization (Centers for Medicare & Medicaid Services, 2012a)
8 MEANINGFUL USE RESTS ON FIVE PILLARS OF HEALTH OUTCOMES POLICY PRIORITIES 1. Improving quality, safety, efficiency, and reducing health disparities 2. Engage patients and families in their health (Centers for Disease Control and Prevention, 2011)
9 MEANINGFUL USE RESTS ON FIVE PILLARS OF HEALTH OUTCOMES POLICY PRIORITIES 3. Improve care coordination 4. Improve population and public health 5. Ensure adequate privacy and security protection for personal health information
10 THEORY DIFFUSION OF INNOVATIONS ROGERS (2003)
11 THEORETICAL FRAMEWORK DIFFUSION OF INNOVATIONS Innovation is an idea or practice that is perceived as new by an individual or other unit of adoption. Diffusion of an innovation is the process by which alteration occurs in the structure and function of a social system. Thus, diffusion is a kind of social change. Rogers (2003) Wikipedia.org
12 LITERATURE REVIEW: EHR BENEFITS E-Prescribing: EHRs can improve patient and provider convenience by making medication more readily accessible.
13 LITERATURE REVIEW: EHR BENEFITS Safety: EHRs improve safety by reducing adverse drug events in the inpatient setting and in the ambulatory setting by focusing on several components of CPOE such as alerts, reminders, warning and potential drug interactions. Hillestad et al., 2005
14 LITERATURE REVIEW: EHR BENEFITS Decision support: EHRs can identify built-in alerts, and reminders, thereby providing decision support capability to assist providers. Ohno-Machado, 2011
15 LITERATURE REVIEW: EHR BENEFITS Workload and productivity: EHRs can reduce paperwork time for providers, and be used to deliver information to public health agencies or quality measurement, saving providers time. Centers for Medicare & Medicaid Services, 2010b
16 LITERATURE REVIEW: EHR BENEFITS Costs: Studies have suggested that the exchange of health information contained in EHRs and other related EHR activity (e.g. reduced paperwork) will have a substantial impact on the health care system s costs. Blumenthal et al., 2006
17 LITERATURE REVIEW: EHR BENEFITS Patient-centeredness: Patients can have a better access to their medical records. EHRs can make a patient s health information available when and where it is needed. EHRs can bring a patient s health services received from different providers in one place, so care is better coordinated. Centers for Medicare & Medicaid Services, 2010b
18 LITERATURE REVIEW: DISADVANTAGES OF USING EHRS Logistical problems: there is a discrepancy between the way EHRs are designed and the way work is actually performed by nurses. Some concerns related to the software not well adapted to the needs of frontline users, and not intuitive or user-friendly enough to improve overall nursing efficiency, to support the work flow as well as the patient care process. Sassen, 2009
19 LITERATURE REVIEW: DISADVANTAGES OF USING EHRS Interoperability: Despite their computerized functions, the EHR system remained highly fragmented. Exchange of patient care information between hospitals or from hospitals to physicians offices is still not optimized. Jha et al., 2009
20 LITERATURE REVIEW: DISADVANTAGES OF USING EHRS Lack of training: Training has in fact been shown to foster positive nurse attitudes toward the EHRs. Nevertheless, mostly because of the associated costs, nurses have reported inadequate EHRs training Sassen, 2009
21 LITERATURE REVIEW: DISADVANTAGES OF USING EHRS Feelings of imposition: If in the process of adopting and implementing EHRs nurses are not included, they may view the technology as something that has been imposed on them and refuse to use it. Sassen, 2009
22 LITERATURE REVIEW: DISADVANTAGES OF USING EHRS Lack of competence: Gaumer et al. (2007), in their study of recent nurse practitioner graduates found that 9 out of 10 of them use computers at work. Yet, a large proportion of them still have low self-perception of information technology competence, believe that academic preparation for HIT as well as on site-training at job are inadequate
23 LITERATURE REVIEW: DISADVANTAGES OF USING EHRS EHRs hinders nursing work through impaired critical thinking, decreased interdisciplinary communication, and a high demand on work time. The nurses also argued that although use of EHRs enables them to provide safer care, it decreases the quality of care. Kossman and Scheidenhelm (2008)
24 STUDY S PURPOSE To gain a better understanding of EHRs utilization by Advanced Practice Nurses.
25 OBJECTIVES 1. to investigate overall differences in APNs EHRsusers vs. non users; 2. to examine how APN EHRs-users compare to nonusers in four US states: Arkansas, Louisiana, Mississippi, and Tennessee; 3. To describe the characteristics of APN EHRsusers as compared to non-users; 4. To study differences in APNs EHRs-users vs. non users in meaningfully use of the technology.
26 RESEARCH METHOD A non-experimental research design Surveys
27 SAMPLING DESIGN Convenience Mailing addresses from SBNs: Tennessee, Arkansas, Louisiana, and Mississippi Post cards sent to APNs
28 DATA COLLECTION APNs socio-demographics and practice characteristics were obtained through an online survey. The survey consisted of a mixture of closedended, open-ended and multiple choice questions
29 IRB University of Arkansas Institutional Review Board approved the research project.
30 QUESTION To investigate the differences between APNs EHRs-users vs. non-users TEST Chi-square test for categorical variables and the Nonparametric test of Mann- Whitney U Test for continuous variables. To determine APNs sociodemographics and practice characteristics associated with the use of EHRs Multivariable logistic regression. ANALYSIS An alpha level of 0.05 was used for all statistical tests.
31 DESCRIPTIVE RESULTS Respondents (N=526) Type of APN nurses practitioners (87.7%) clinical nurse specialists (9%) certified nurse midwives (3.3%)
32 RACE AND GENDER OF THE SAMPLE White (91.2%) African American (6.6%), Asian 1.4% Hispanic 0.8%. Female (88.8%).
33 DIFFERENCES BETWEEN EHRS-USERS AND NON- USERS BY STATE States EHRs-Users EHRs-non users (%) (%) Four states combined Arkansas Louisiana Mississippi Tennessee
34 AGE APNs over 55 years of age are the least likely adopters of EHR technology; only 16.3% use it.
35 PLACE OF EMPLOYMENT APNs who reported practicing exclusively at the hospital setting are more likely to use EHRs (35.2% vs. 17%).
36 MULTIPLE LOGISTIC REGRESSION The more patients APNs see the least likely they are to use EHRs The more patients APNs see at the hospital setting as compared to the clinic setting, the more likely they are to use EHRs APNs with more years of professional experience are more likely to use EHRs
37 MULTIPLE LOGISTIC REGRESSION Multiple logistic regressions further showed no statistically significant differences between EHRs-users and non-users in most characteristics
38 LIMITATIONS A non-probabilistic sampling was used (convenience sample) which limits generalizability. Small sample (N=526) Study might be too early- Stage 1 had not been completed yet, therefore our findings cannot be extrapolated to the whole duration of Stage 1
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