Patient and nurse perceptions of electronic medical records in an acute setting: A multi-method qualitative study

Electronic medical records are progressively replacing paper records in many healthcare settings worldwide. However, the patient experience is not well represented in the published literature. Research on nurses' experience using the electronic medical record has shown increased documentation burden, time spent-on-computers and concerns for the negative impacts on patient-centred care. Further understanding is warranted of both patient and nurse experience of the electronic medical record.

This study aimed to explore the experiences of patients and nurses with electronic medical records, and the impact of computers on nurses' documentation, practice, and interaction with patients in their care.

A multi-method qualitative study comprising an ethnographic observational component, followed by interviews of nurses and patients.

The Cardiac Centre (cardiac ward and coronary care unit) in a regional tertiary hospital in northern Australia.

Inpatients and nurses working clinically in the Cardiac Centre were invited to participate.

The initial phase, during April-July 2022, involved in-depth observations of the impact of the electronic medical record and computers-on-wheels on nurses' practice and interactions with patients. The second phase, during January 2023, comprised semi-structured interviews with patients and nurses to further explore their perspectives and attitudes towards electronic medical records and computers. Information sheets were provided, and written consent forms were obtained, for both phases. Field notes were analysed deductively, and interview transcriptions were analysed thematically. Findings have been presented descriptively with themes explained using quotes from participants supported by observations.

Observation periods totalled 1220 min. In the times observed, nurses spent approximately one-third of their time using the computer. Interviews and observations revealed two themes: 'Moving ahead with the times' and 'A balancing act'. Both patients and nurses agreed that accessible information in the electronic medical record improved timely communication between health professionals; however, balancing nursing care with managing digital technologies presented physical and professional challenges for the nurses. Despite these challenges, the patients were supportive of the technology and saw it as beneficial to their health outcomes.

While patients and nurses generally accepted the electronic medical record, our findings reveal tensions between technological adaptation and clinical practice, underscoring the need to include patient and nurse perspectives to ensure digital systems support person-centred care. Balancing the demands of clinical realities with person-centred care in the context of evolving technological innovations will be key to improving satisfaction with the healthcare system.