This paper outlines the presentation of EHR to hospital nurses one week before implementation of a new EHR system. It focuses on the role of a modern nurse as an agent of change in facilitation of adopting new technologies and discusses the benefits of EHR implementation.
Introduction & Background
Healthcare is evolving all the time. Wave after wave of innovative technologies, information systems, insurance models, regulatory changes, as well as institutional arrangements characterize the system. Yet, people and institutions involved in it do not actually like change. This seems uncertain and difficult, and this is painful.
Entire healthcare organizations within healthcare perform either a role of promoters of innovation, as they sell the latest drugs, implement new imaging systems, or develop software packages, or a role of preventers of innovations from their disruption of the status quo, as they counter deal, keep drug representatives away from physicians, disallow reimbursement or refuse to implement innovative approaches to healthcare management. Trying to alter the pace at which innovative ideas about healthcare permeate the system has been a healthcare professionals’ priority. These changes are thought to easily have a major impact on quality, cost, and patient satisfaction.
For over a decade, our government alongside health advocacy groups that electronic health records (EHR) should be extensively used as a means of enhancing patient safety, reduce costs, and improve the quality of healthcare services. The adoption of EHR can help nurses accomplish their daily routines as well as record-keeping jobs more effectively and efficiently. Moreover, EHR use will significantly improve the hospital performance if utilized by the healthcare staff. For example, a recent study by King et al. (2014) found that the use of EHR enhances patient care overall, as well as facilitates patient communication, reduces the potential to a medical error, helped order relevant tests, eased access to patients’ charts remotely. However, to maximize HER benefits it is critical for the hospitals to obtain nurses’ support. One of the best approaches is acknowledging the role of nurses as modern agents of change and agents of innovations diffusion.
Nurses as Agents of Innovations Diffusion
“Diffusion is the process by which an innovation is communicated through certain channels overtime among the members of a social system.” This is the definition provided by Everett Rogers, who is the author of a vast body of literature spanning over 50 years in his classical work Diffusion of Innovation. Let us trace, based on Rogers theory, how the dynamics of innovation is important and how it plays out within healthcare. In order for an innovative technology to be implemented successfully, the following qualities should be present. They will determine how individuals will perceive the perspectives of adopting a new technology and will shape their attitude.
The first quality is relative advantage. Based on Rogers (2003), an individual should see how a proposed innovation will be an improvement over the way the things were done previously. As it has already been shown, research data provide evidence that the use of EHR brings positive clinical benefits, with 78% of physicians reporting that the use of HER improved patient health care overall (King et al., 2014). If to apply this quality (of relative advantage) to the context of the hospital, it will enhance patient care, enhance benefits related to recommended care, help physicians order relevant tests, will help them access patients’ charts remotely, will alert them to potential errors as well critical lab values, etc. Moreover, EHR use will considerably benefit the patients with chronic diseases, such as diabetes, coronary disease, heart failure, asthma, and hypertension, etc (More et al., 2013). Now to see the potential of how relative advantage quality can play out in HER, let us investigate its impact on another technology innovation. For example, the use of minimally invasive surgery, whereby physicians use specialized instruments and a video camera to enter the patient’s body via small incisions and then move to the needed area without exposing the whole body cavity, has helped minimize the amount of traumas, surgical complications, as well as patient time in hospital in comparison with the traditional removal of the gallbladder (Rogers, 2003).
Next, this is the quality of compatibility with already existing practices and values. It is about the adopter’s ability to see how the current innovation aligns with previous practices (Rogers, 2003). The more a particular innovation can coexist and integrate into existing technologies as well as social patterns the greater its prospects for diffusion and adoption. With reference to EHR, the computer software packages have long been used in healthcare to manage healthcare delivery process; moreover, nurses as well as physicians are well-versed in computer technology these days. Therefore, there is an installed base of technology, which will ease the implementation.
Further, trialability refers to the adopter’s possibility of playing around with and exploring the new technology in practice (Rogers, 2003). With EHR, nurses will have a chance to try it out first on the basis of another hospital, which has already adopted it. This will help them overcome initial uncertainty regarding EHR, when they will try EHR out in a clinical setting where it would fit with other systems.
Simplicity refers to the adopter’s belief that he or she can easily master the innovation. Since the EHR system is easy to comprehend and easy to master, it has a good diffusion potential within the hospital (Cain & Mittman, 2002).
Observable results quality refers to the opportunity for the adopter to see that the current evidence shows that the innovation has been successful in other, previous situations/ hospital settings. With reference to EHR, there is evidence of its successful use in small medical practices across the United States and globally (King et al., 2014; Moore et al., 2013; Kuang-Ming et al., 2013).
Considering the role of nurses as change agents, let us define what a change agent is. A change agent is generally viewed to be an individual that influences clients’ innovation-decisions towards a direction that is deemed desirable by the organization that is defined as change agency. In other words, the task of nurses as change agents of innovation diffusion is to help win over the support of EHR by the hospital’s patients.
Overall, nurses in the small hospital in upstate New York have a good potential for becoming change agents of EHR within their healthcare setting. Having assessed the potential of the innovative technology for diffusion across the five qualities proposed by Rogers (2003), it can be claimed that the ease of implementation will be fostered by the EHR’s relative advantage, trialability, simplicity, observable results, and its compatibility with already existing practices and values. This conclusion is based on a range of current findings on specifics of EHR implementation and on Rogers Diffusion of Innovation theory (Rogers, 2003). Therefore, it is recommended that nurses in the small hospital in upstate New York should re-assess the potential effects and details of practice with the use of EHR, so that no barriers would be created on their side. Hopefully, the use of Rogers approach will help them become the agents of change within their healthcare setting.
- King, J., Patel, V., Jamoom, E. W., & Furukawa, M. F. (2014). Clinical Benefits of Electronic Health Record Use: National Findings. Health Services Research,49 (1pt2), 392-404. doi:10.1111/1475-6773.12135.
- Kuang-Ming, K., Chung-Feng, L., & Chen-Chung, M. (2013). An investigation of the effect of nurses’ technology readiness on the acceptance of mobile electronic medical record systems. BMC Medical Informatics & Decision Making, 13 (1), 1-14. doi:10.1186/1472-6947-13-88.
- Moore, K. D., Eyestone, K., & Coddington, D. C. (2013). costs and benefits of EHRs: a broader view. Hfm (Healthcare Financial Management), 67(4), 126.
- Rogers, E. M. (2003). Diffusion of innovations (5th ed.). New York, NY: Free Press.