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Cho, Choi, Choi, Hyun, Park, Lee, Cho, and Hwang: Identifying Usability Level and Factors Affecting Electronic Nursing Record Systems: A Multi-institutional Time-motion Approach
Original Article

Journal of Korean Academy of Nursing 2015; 45(4): 523-532.

Published online: 31 August 2015

DOI: https://doi.org/10.4040/jkan.2015.45.4.523

Identifying Usability Level and Factors Affecting Electronic Nursing Record Systems: A Multi-institutional Time-motion Approach

Insook Cho1, Won-Ja Choi2, WoanHeui Choi3, Misuk Hyun4, Yeonok Park5, Yoona Lee6, Euiyoung Cho7, Okhee Hwang8

1Department of Nursing, Inha University, Incheon, Korea.

2Department of Nursing, SMG-SNU Boramae Medical Center, Seoul, Korea.

3Department of Nursing, Seoul National University Hospital, Seoul, Korea.

4Department of Nursing, Dongguk University Ilsan Hospital, Goyang, Korea.

5Department of Nursing, Ajou University Hospital, Suwon, Korea.

6Department of Nursing, Korea University Guro Hospital, Seoul, Korea.

7Department of Nursing, Pai Chai University, Daejeon, Korea.

8Department of Nursing, National Cancer Center, Goyang, Korea.

Address reprint requests to: Cho, Insook. Department of Nursing, Inha University, 100 Inha-ro, Nam-gu, Incheon 22212, Korea. Tel: +82-32-860-8201, Fax: +82-32-874-5880, insook.cho@inha.ac.kr

Received 30 September 2014       Revised 19 October 2014       Accepted 22 April 2015

© 2015 Korean Society of Nursing Science

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0/) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

The usability, user satisfaction, and impact of electronic nursing record (ENR) systems were investigated.

Methods

This mixed-method research was performed as a time-motion (TM) study and a survey which were carried out at six hospitals between August and November 2013. The TM study involved 108 nurses from medical, surgical, and intensive care units at each hospital, plus an additional 48 nurses who served as nonparticipating observers. In the survey, 1879 volunteer nurses completed the Impact of ENR Systems Scale, the System Usability Scale, and a global satisfaction scale. Qualitative and quantitative analyses were performed.

Results

The mean scores for the ENR impact, system usability, and satisfaction were 4.28 (out of 6), 58.62 (out of 100), and 74.31 (out of 100), respectively, and they differed significantly between hospitals (F=43.43, p<.001, F=53.08 and p<.001, and F=29.13 and p<.001, respectively). A workflow fragmentation assessment revealed different patterns of ENR system use among the included hospitals. Three user characteristics-educational background, practice period, and experience of using paper records-significantly affected the system usability and satisfaction scores.

Conclusion

The system quality varied widely among the ENR systems. The generally low-to-moderate levels of system usability and user satisfaction suggest many opportunities for improvement.

Keywords: Electronic health records, Nursing records, Time and motion studies, User-computer interface, Work satisfaction

Figures and Tables

Figure 1

Research framework of clinical impact and usability of electronic nursing record systems.

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Figure 2

Comparisons the scores of impact of the system, system usability, and overall satisfaction.

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Figure 3

The 'timeline belt' visualization exhibiting nursing activity fragmentation of a medical nursing units.

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Table 1

Characteristics of Nurses Participated in the Self-reporting Questionnaire

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a, b, cGroup contrast by Tukey test; CI=Confidence interval; ENR=Electronic nursing records.

Table 2

Multiple Regression of Respondent's-characteristics-adjusted Impact of ENRs, Usability Score of ENR, and Overall Satisfaction on ENR

jkan-45-523-i002

ENR=Electronic nursing record.

Notes

This study was supported by the Hospital Nurses Association of Korean Nurses Association in 2013.

This study was also supported by a grant from Inha University in 2014 (No. 50463-01).

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