Nursing Informatics 2018 241

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doi:10.3233/978-1-61499-872-3-241

The Actual Use of an Electronic Medical Record (EMR) by Acute Care Nurses:
Examining a Multidimensional Measure at Different Adoption Stages
Éric Maillet, RN, PhDa, Claude Sicotte, PhDb, Luc Mathieu, RN, PhDa
a
Faculty of Medicine and Health Sciences, University of Sherbrooke, Quebec, Canada,
b
Health Administration Department, School of Public Health, University of Montreal, Quebec, Canada

Abstract 524 female nurses and 92 male nurses. Table 1 shows the results
of the multidimensional usage for each EMR adoption stage.
An EMR should support the informational needs of nursing
practice. However, a multidimensional measure of the actual
Table 1 – Average, standard deviation and R2 scores for the
use of an EMR in hospitals ranked at different adoption stages
multidimensional usage for each EMR adoption stage
revealed significant results that should be addressed to enable
nurses to bring their full contribution to their patients and to Adoption
the healthcare team. Setting Stage Average SD R2
Hospital 1 1 42.14 10.51 13.0%
Keywords: Hospital 2 2 44.46 10.93 30.4%
Hospital 3 3 35.19 12.65 37.6%
Electronic Health Records (EHR), Meaningful use, Nurses.
Hospital 4 4 35.01 12.54 32.4%
Total sample 37.22 12.70 33.6%
Introduction SD: standard deviation. R2: squared multiple correlation

More than ever, information technology is leveraged to address Conclusion

health care system challenges, and to create new ways of
delivering health care [1]. An electronic medical record (EMR)
should support the assessment, diagnosis, outcomes
identification, planning, implementation and the evaluation of
patient care [2]. However, the implementation of an EMR has
not necessarily translated into benefits for nurses in terms of
meaningful or effective use [3]. To measure the acceptance of
IT by end users, researchers mostly focused on the intention to
use the system, a proxy considered sufficiently close to the
actual use behaviour [4]. Some studies measured the actual use
in terms of frequency, duration and extent of use of the system.
For nurses, this measure appears rather reflective of workflow
interruptions and the complexity of patient care needs. A recent
study [5] measured the actual use of an EMR according to three
fundamental IT functions: 1) decision support, 2) work
integration, and 3) patient care [6]. The aim of this poster is to
examine the actual use of an EMR by acute care nurses at
different adoption stages.
Methods
The data were collected between October 2012 and March 2013
in four academic hospitals located in Montreal, Canada as part
of a multicenter cross-sectional study. Hospitals ranked at
stages 1 and 2 also had a nursing care plan software used by
nurses before the implementation of the EMR. A stratified
random sampling method was conducted to select the 875
nurses in medical and surgical wards. The actual use of the
EMR was measured by a summated scale of 14 items targeting
five subdimensions of IT functions: 1) problem solving, 2)
decision rationalization, 3) horizontal integration (between
members of the same working group), 4) vertical integration (in
a superior-subordinate perspective), and 5) patient care.
Results
A total of 616 questionnaires were eligible for structural
equation modeling techniques. The final sample consisted of
This study is the first 1) to have measured the behavioral
response of users according to a multidimensional measure of
the actual use of an EMR and 2) to have collected results
according to 4 different adoption stages. A meaningful measure
of the actual use of an EMR according to adoption stages and
to system functionalities revealed significant differences that
should be addressed to enable nurses to bring their full
contribution to their patients and to the healthcare team.
Acknowledgements
The first author is grateful for scholarships received from the
FERASI Center, the Ministère de l’Éducation, du Loisir et des
Sports of Quebec and the Quebec Nursing Intervention
Research Network
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Correspondence

Éric Maillet, School of Nursing, Faculty of Medicine and

Health Sciences, University of Sherbrooke, Canada.
Email: eric.maillet@usherbrooke.ca