title: Nurses' use of an integrated electronic health record: results of a case site analysis.
abstract: OBJECTIVE
  To explore how nurses use an integrated Electronic Health Record (EHR) in practice.
  
  
  METHODS
  A multi-site case study across two hospitals in Kaiser Permanente Northern California. Non-participant observation was used to explore nurses' use of the EHR, while semi-structured interviews with nurses and managers explored their perceptions of the EHR and how it affected their practice. Data were analyzed thematically using codes derived deductively from the literature and inductively from the data.
  
  
  RESULTS
  Key themes arising from the analysis suggest that the EHR changed various elements of the way nurses practiced. Introducing the EHR was thought to have improved communication, ease of access to information and the safety of medication administration processes. At an organizational level, there was variability in how the EHR was used to support care documentation and initiatives to improve the quality of care provided by nurses.
  
  
  CONCLUSIONS
  The EHR was perceived to improve efficiency, safety and communication by the majority of nurses who were interviewed. However, it is likely that a number of other factors such as individual nurse's characteristics and organizational culture influence how an EHR can be used effectively to improve outcomes for patients.
authors.affiliation: a Columbia University School of Nursing , New York , NY , USA.|b Center for Home Care Policy and Research, Visiting Nurse Service of New York , New York , NY , USA.
authors.forename: Dawn W
authors.initials: DW
authors.lastname: Dowding
authors.affiliation: c Department of Health Information Technology Transformation & Analytics , Kaiser Permanente Program Office , Portland , OR , USA and.
authors.forename: Marianne
authors.initials: M
authors.lastname: Turley
authors.affiliation: d Department of Health Information Technology Transformation & Analytics , Kaiser Permanente , Oakland , CA , USA.
authors.forename: Terhilda
authors.initials: T
authors.lastname: Garrido
keywords: Case site study; electronic health records; nursing informatics; quality of health care