Few studies have evaluated the usability of electronic health record (EHR) systems from a nurse's perspective. Researchers designed a study to examine the independent and joint effects of comprehensive EHR system adoption and the hospital work environment on nurses' assessment of EHR usability and quality of care and safety. They analyzed data from a nurse survey and two American Hospital Association databases. The sample included 12,377 staff nurses in 353 hospitals, of which 157 had a comprehensive EHR system and 196 had a basic EHR system or less.

Nurses working in a hospital with a comprehensive system were less likely to express dissatisfaction with the system. Work environment independently affected all usability ratings. Compared with nurses working in hospitals with a poor work environment, nurses in hospitals with a better work environment were less likely to be dissatisfied with the EHR system, to report poor usability outcomes, and to report not being involved in choosing or modifying the system. Nurses working in a hospital with a comprehensive EHR system and a better work environment were less likely to rate quality of care as fair or poor. A poor work environment, even with a comprehensive EHR system in place, was also associated with nurse reports of a poor patient safety grade.

The authors conclude that the best patient outcomes may be achieved by both implementing a comprehensive EHR system and improving the hospital work environment.

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