Staff utilisation of an electronic medical record during nursing handover

Electronic medical records (EMRs) are widely implemented to improve information access, patient safety and care coordination. However, less is known about how EMRs are used in routine clinical processes such as nursing handover. Understanding how EMRs influence handover practices is important, given the central role of handover in continuity of care and patient safety.

An exploratory mixed-methods comparative case study using a cross-sectional survey design was conducted within a large multi-site public healthcare organisation in Victoria, Australia. An organisation-wide survey captured quantitative data on EMR use during preparation for and delivery of nursing handover, alongside qualitative free-text responses exploring perceived impacts, barriers and facilitators. Responses were compared between EMR-enabled clinical areas and predominantly paper-based or hybrid environments.

A total of 385 nurses completed the survey. EMR use during handover was substantially higher in EMR-enabled environments than in paper-based or hybrid settings. Qualitative analysis identified six key areas influencing handover: access to and visibility of clinical information; handover quality, safety and cognitive focus; usability and fit with nursing practice; system implementation and enabling conditions; impact on nursing workflows and time and bedside handover and patient engagement. EMR not only supported information access and verification during handover but also introduced cognitive and workflow challenges, particularly where usability, infrastructure or implementation maturity were limited.

EMR use can support safer and more informed nursing handover by improving access to legible, real-time clinical information. However, its effectiveness is contingent on usability, infrastructure and alignment with nursing workflows, consistent with the principles of task-technology fit. Hybrid documentation environments and system access constraints limit the consistent realisation of benefits. Continued reliance on printed summaries, handwritten notes and personalised tools suggests that digital systems may complement, rather than completely replace, existing cognitive supports. Optimising EMR-supported handover requires organisational attention to implementation conditions, workflow integration and the practical realities of clinical work.Implications for health information management practice:Health information management professionals can contribute to EMR optimisation by supporting the accessibility, organisation and effective use of clinical information. Evaluation of information usability, documentation practices and ongoing reliance on paper-based workarounds can help identify opportunities to better support clinical information needs.