title: Transitioning from a computerized provider order entry and paper documentation system to an electronic health record: expectations and experiences of hospital staff.
abstract: OBJECTIVE
  To examine healthcare worker's perceptions, expectations, and experiences regarding how work processes, patient-related safety, and care were affected when a quaternary care center transitioned from one computerized provider order entry (CPOE) system to a full electronic health record (EHR).
  
  
  METHODS
  The I-SEE survey was administered prior to and 1-year after transition in systems. The construct validity and reliability of the survey was assessed within the current population and also compared to previously published results. Pre- and 1-year post-implementation scale means were compared within and across time periods.
  
  
  RESULTS
  The majority of respondents were nurses and personnel working in the acute care setting. Because a confirmatory factor analysis indicated a lack of fit of our data to the I-SEE survey's 5-factor structure, we conducted an exploratory factor analysis that resulted in a 7-factor structure which showed better reliability and validity. Mean scores for each factor indicated that attitudes and expectations were mostly positive and score trends over time were positive or neutral. Nurses generally had less positive attitudes about the transition than non-nursing respondents, although the difference diminished after implementation.
  
  
  CONCLUSIONS
  Findings demonstrate that the majority of responding staff were generally positive about transitioning from CPOE system to a full electronic health record (EHR) and understood the goals of doing so, with overall improved ratings over time. In addition, the I-SEE survey, when modified based on our population, was useful for assessing patient care and safety related expectations and experiences during the transition from one CPOE system to an EHR.
authors.affiliation: Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. Electronic address: eric.kirkendall@cchmc.org.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Kirkendall
authors.forename: Linda M
authors.initials: LM
authors.lastname: Goldenhar
authors.forename: Jodi L
authors.initials: JL
authors.lastname: Simon
authors.forename: Derek S
authors.initials: DS
authors.lastname: Wheeler
authors.forename: S
authors.initials: S
authors.lastname: Andrew Spooner
mesh_terms: D001291:Attitude of Health Personnel; D057286:Electronic Health Records; D005163:Factor Analysis, Statistical; D006801:Humans; D007588:Job Satisfaction; D050316:Medical Order Entry Systems; D009820:Ohio; D009936:Organizational Innovation; D010564:Personnel, Hospital / Q000523:psychology*
keywords: Electronic health records; Medical informatics; Patient safety; Quality of healthcare; User satisfaction