G Model

COLEGN-587; No. of Pages 21 ARTICLE IN PRESS

Collegian xxx (2018) xxx–xxx

Contents lists available at ScienceDirect

Collegian
journal homepage: www.elsevier.com/locate/coll

Review

Measuring nursing benefits of an electronic medical record system: A

scoping review
Rebecca M. Jedwab a,∗ , Cheyne Chalmers a,c , Naomi Dobroff a,c , Bernice Redley b,c
a
Monash Medical Centre Clayton, Monash Health, 246 Clayton Road, Clayton, Victoria, 3168, Australia
b
Centre for Quality and Patient Safety Research – Monash Health Partnership, Level 2 I Block, 246 Clayton Road, Clayton, Victoria, 3168, Australia
c
Deakin University, School of Nursing and Midwifery, Geelong, 221 Burwood Highway, Burwood, Victoria, 3125, Australia

a r t i c l e i n f o a b s t r a c t

Article history: Background: Nurses are expected to be the largest users of electronic medical records in hospitals. Liter-
Received 15 October 2018 ature specific to measuring the impacts of an electronic medical record implementation on the quality
Received in revised form of nursing work has not been examined.
15 November 2018
Aim: Report a scoping review to identify measures useful to evaluate the nursing benefits of electronic
Accepted 16 January 2019
medical records implementation in the Australian hospital context.
Available online xxx
Methods: Search terms included combinations of synonyms for: nursing, electronic medical record, and
healthcare quality. Data were extracted from eligible papers using an established five-step scoping review
Keywords:
Electronic medical record process. Eligible papers and extracted data were independently checked by two reviewers.
Evidence-based practice Findings: 120 papers were located by systematic searching of five databases and grey literature from
Nursing research peak bodies. A framework integrating three domains of nursing work with Donabedian’s quality model
Patient safety resulted in a matrix of 168 measures relevant to evaluating technology impact on the quality of nursing
Quality work.
Scoping review Discussion: Measures addressed structures, processes and outcomes of nursing work for fundamental
nursing care and harm prevention; however a gap emerged in relation to measuring individualised nurs-
ing care. Variability in measures and mixed reports of impacts of electronic medical records on nursing
work and patient care delivery were identified.
Conclusion: The scoping review identified measures useful to inform a quality assessment framework to
examine nursing benefits of electronic medical records in Australian hospitals. Next steps include testing
the validity, reliability and sensitivity of indicators to evaluate the impact of an implementation strategy.
Future research should identify measures to examine quality of individualised care.
© 2019 Australian College of Nursing Ltd. Published by Elsevier Ltd.

Contents

Summary of relevance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
Problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
What is already known . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
What this paper adds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
1.1. Background and theoretical framework . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
1.2. Review question . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
2. Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
3. Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
3.1. Structure measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00

∗ Corresponding author at: C/O Dr Bernice Redley, Level 2 I Block, Centre for Quality
and Patient Safety Research – Monash Health Partnership, Monash Medical Centre
Clayton, 246 Clayton Road, Clayton, Victoria, 3168, Australia.
E-mail address: rebecca.jedwab@monashhealth.org (R.M. Jedwab).

https://doi.org/10.1016/j.colegn.2019.01.003
1322-7696/© 2019 Australian College of Nursing Ltd. Published by Elsevier Ltd.

Please cite this article in press as: Jedwab, R. M., et al. Measuring nursing benefits of an electronic medical record system: A scoping
review. Collegian (2018), https://doi.org/10.1016/j.colegn.2019.01.003
G Model
COLEGN-587; No. of Pages 21 ARTICLE IN PRESS
2 R.M. Jedwab et al. / Collegian xxx (2018) xxx–xxx

3.1.1. Nursing language . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00

3.1.2. Nurse work-time distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
3.1.3. Nursing documentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
3.2. Process measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
3.2.1. Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
3.3. Outcome measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
3.3.1. Missed nursing care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
3.3.2. Preventable patient harms and complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
3.3.3. Length of stay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
3.3.4. Experience and satisfaction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
4. Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
5. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
Ethical statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
Conflict of interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
Acknowledgement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00

Summary of relevance where nursing care takes place. Little is known about how, and if,
implementation of an EMR translates into direct or indirect benefits
Problem for nursing work, and how these relate to patients’ outcomes sen-
sitive to nursing care quality. This paper reports a scoping review
Measurement of electronic medical record implementation to identify measures useful to evaluate the nursing benefits of EMR
benefits need to capture the quality and safety focus of nursing implementation relevant to the Australian hospital context. The
practice in Australian hospitals. outcomes are expected to inform a strategy to evaluate the impact
of EMR implementation on the quality and safety of nursing work.
What is already known
1.1. Background and theoretical framework
Evaluations of the benefits of electronic medical records often
overlook nurses’ critical role in quality and safety of healthcare
In Australia, the transition from paper to electronic health
delivery.
records has been a slow but inevitable process. As a late adopter,
the Australian healthcare system has the unique opportunity to
What this paper adds learn from international EMR implementation and mitigate poten-
tial problems. International literature reporting benefits of EMR
This review identified a matrix of measures to inform evalua- implementation typically focuses on financial issues or use of EMR
tion of the impact of electronic medical record implementation on by physicians. This is reflective of US style systems, founded on
the quality and safety of nursing work in Australian hospitals. A models of privatised billing, where most vendors originate. In
gap in measures to examine nurses’ delivery of individualised or contrast, nursing practice in the Australian healthcare system is
condition-specific care was identified. based on a British model of care that is patient-centred, multi-
disciplinary, quality focussed and predominantly publicly funded.
1. Introduction Nursing practice in Australia is underpinned by the nursing process
of cyclical steps of assessment, planning, intervention and evalua-
Electronic medical record (EMR) systems are changing the tion of patient care (Kitson, Conroy, Kuluski, Locock, & Lyons, 2013)
landscape of healthcare practice globally. Replacing traditional and informed by national quality and professional standards.
paper-based information systems, EMRs provide nurses with a cen- Since the 1990s, a large number of indicators have been used to
tralised and accessible source of electronic clinical information. benchmark healthcare quality standards, and subsequent patient
Electronic systems can offer a range of opportunities to improve outcomes, to encourage clinical practice improvements in nursing
nurses’ work through access to information, enhanced workflows care delivery across settings and jurisdictions (Brown, Donaldson,
and guidance for care practices. To date, evaluations of the benefits Bolton, & Aydin, 2010; Burkett, Martin-Khan, & Gray, 2017). How-
of EMR systems reported in international healthcare literature tend ever, little is known about whether these indicators are useful to
to reflect a focus on economic drivers such as revenue and busi- examine impacts of EMR implementation. Literature evaluating
ness management, rather than the quality and safety of patient care EMR implementation for nursing work is sparse, and the limited
that underpins nurses’ work in Australia’s predominantly publicly work available reporting the impacts of technology on the quality
funded health system (Australian Commission on Safety & Quality of nursing work is inconsistent (Nguyen & Wickramasinghe, 2017;
in Health Care, 2017b). Rogers, Sockolow, Bowles, Hand, & George, 2013; Zhang & Zhang,
There has been limited evaluation of the healthcare quality and 2016).
safety benefits of EMR implementation. In particular, potential ben- As the largest professional workforce in hospitals, nurses have
efits specific to the quality and safety of nursing care are often a critical role in successful EMR implementation and subsequent
overlooked despite nurses’ critical roles in healthcare delivery. impacts on patient care (Advisory Board International Global Centre
Nursing professionals comprise the largest proportion of the health for Nursing Executives, 2015; Snowden & Kolb, 2017). In Australia,
workforce (Australian Institute of Health & Welfare, 2018), hence nurses work both autonomously and collaboratively with other
are the highest users of EMRs in hospitals. Nursing care directly health professionals to deliver safe, high quality care. Legisla-
influences patient care outcomes in hospitals. However, examina- tion, professional standards, codes and guidelines regulated by
tions of the benefits of EMR have often failed to capture impacts the Nursing and Midwifery Board of Australia guide nurses’ prac-
on nursing work and clinical workflows across the many contexts tice, whilst the Australian Commission on Safety and Quality in

Please cite this article in press as: Jedwab, R. M., et al. Measuring nursing benefits of an electronic medical record system: A scoping
review. Collegian (2018), https://doi.org/10.1016/j.colegn.2019.01.003
G Model
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R.M. Jedwab et al. / Collegian xxx (2018) xxx–xxx
Health Care guide the practices and standards of the health ser-
vices (Australian Commission on Safety & Quality in Health Care,
2017a; Nursing & Midwifery Board of Australia, 2018a, 2018b,
2018c). Healthcare in Australia is expected to be safe, high quality,
consumer-centred, driven by information and organised for safety
(Australian Commission on Safety & Quality in Health Care, 2017a).
Implementing a hospital EMR system is therefore expected to sup-
port nurses to meet their professional responsibilities across the
three domains of clinical nursing work:
1 Meeting the fundamental care needs of patients. This includes
physiological, psychological, sociocultural, comfort, mobility,
nutrition, elimination, environment, hydration and hygiene
needs (Kitson et al., 2013).
2 Preventing iatrogenic harms. Up to one in four patients may expe-
rience an in-hospital complication or harm, most of which are
preventable through consistent high quality care (Nabhan et al.,
2012). Preventable harms contribute significant financial, phys-
ical and emotional burdens to patients, their families and the
healthcare system (Duckett, Jorm, Danks, & Moran, 2018).
3 Providing patient-centred, condition-specific care. Nursing care
should be tailored to the patient’s preferences and goals, and
planned and delivered in partnership with the patient and
healthcare team (Nursing & Midwifery Board of Australia, 2016).
1.2. Review question
The current gap in knowledge about how to measure the impact
of EMR implementation on the quality of nursing work guided the
aim of this scoping review to address the following question: What
measures can evaluate the impact of implementing an EMR on the
quality and safety of nursing work in Australian hospitals?
2. Methods
A scoping review is a methodology used to search, summarise
and communicate the breadth and depth of a research topic, and
can be used to examine the range of existing research, identify
gaps or determine the value of conducting a full systematic review
(Arksey & O’Malley, 2005; Levac, Colquhoun, & O’Brien, 2010). This
study used Arksey and O’Malley (2005) five-step systematic scop-
ing review framework which was chosen to capture the breadth,
complexity and scope of literature evaluating the impact of EMR
implementation on nursing work in hospital settings.
Step 1: The review question was developed using the PICO
framework (Rycroft-Malone & Bucknall, 2010) where the Popula-
tion of interest was nurses working in hospitals; the Intervention
was an EMR system (digital health or associated technology); the
Comparator was care processes associated with paper records; and
the Outcome was indicators that measure the quality and safety
of nursing work relevant to EMR implementation in the Australian
hospital context.
Step 2: A preliminary scoping of the literature was undertaken
using healthcare databases to identify key concepts, develop a
search strategy and establish inclusion and exclusion criteria.
Step 3: The literature search was independently checked by
an expert health librarian, and conducted by the primary author
(RJ) on 15 January 2018 using five healthcare databases (Medline
Complete, ProQuest, ScienceDirect, Scopus and Cochrane Library).
In addition, grey literature and published reports from peak Aus-
tralian healthcare and nursing bodies including the Australian
Commission on Safety and Quality in Health Care, the Australian
Government Department of Health, the Australian Nursing and
Midwifery Federation, the Australian Institute of Health and Wel-
fare, Safer Care Victoria, and the Advisory Board of the healthcare
Please cite this article in press as: Jedwab, R. M., et al. Measuring nursing benefits of an electronic medical record system: A scoping
review. Collegian (2018), https://doi.org/10.1016/j.colegn.2019.01.003
3
organisation of the primary author (RJ) were included to ensure rel-
evance to the Australian nursing context. Synonym combinations
of the search terms used are presented in Table 1.
Step 4: The titles, abstracts and full text of identified papers were
independently screened by two members of the research team to
exclude papers that did not meet the inclusion criteria. Inclusion
criteria included English language papers, full text availability, and
publication within the last 15 years (after 2002) to ensure rele-
vance to current clinical practices and EMR implementation. All
study designs and document types were included in the scoping
review including theses and literature reviews. Exclusion criteria
were limited to non-English language articles, opinion papers and
those considered not relevant to nursing work or EMR implemen-
tation.
Step 5: Data extraction was guided by Donabedian’s structure-
process-outcome quality of care model (Donabedian, 1988) and
a framework of three interrelated domains of nursing work:
1) Fundamentals of nursing care (Kitson et al., 2013); 2) Pre-
venting complications and harms of hospitalisation (Australian
Commission on Safety & Quality in Health Care, 2017a; Redley &
Baker, 2018; Redley & Raggatt, 2017); and 3) Tailored condition-
specific and individualised care (Australian Commission on Safety
& Quality in Health Care, 2017a; Kitson et al., 2013).
3. Results
The search identified 460 papers from the databases, and a fur-
ther 15 papers from grey literature. After screening titles, abstracts
and full text, 120 suitable papers were included in the review (see
Fig. 1).
Papers were published between 2002 and 2017. The majority
were from the USA (57.5%, n = 69); 15.8% (n = 19) were Australian
publications; and the remaining 26.7% (n = 32) represented other
countries including the United Kingdom, Sweden, South Korea and
The Netherlands. Most (70%, n = 84) were primary research; 16.
7% (n = 20) were review papers; 5.8% (n = 7) were guidelines, 6.7%
(n = 8) were systematic reviews, of which 4 reported meta-analyses
(3.3%); and 0.8% (n = 1) was a database. Whilst only 30.8% (n = 37)
of the papers were nursing-specific, another 32.5% (n = 39) had
relevance to both nursing and medical professionals; 1.7% (n = 2)
related to both nursing and midwifery professionals; 3.3% (n = 4)
related to EMR and medical professionals; 13.3% (n = 16) related to
nursing, medical and pharmacy professionals; and the remaining
18.3% (n = 22) were relevant to all healthcare professions. Just over
one third (36.7%, n = 44) reported post-implementation studies and
few (10%, n = 12) reported both pre- and post-implementation data;
none were randomised trials. In addition, 8.3% (n = 10) reported pre-
post studies to examine one or more changes in an existing EMR
such as addition of an alert or changed reporting. Most (80%, n = 96)
of the included studies were conducted in hospital settings and a
few (8.3%, n = 10) included both hospital and community organi-
sations. Characteristics of the included studies and the measures
reported are summarised in Table 2.
Consistent with the scoping review method, a formal quality
appraisal of the included studies and papers was not undertaken
(Arksey & O’Malley, 2005; Levac et al., 2010).
Overall, 168 measures identified as useful to evaluate the qual-
ity of nursing work were drawn from the included studies. Of these,
60 measures related to the foundations of nursing care, 103 to pre-
ventable harms of hospitalisation, and 5 to condition-specific care
delivery; 24 were structure measures, 9 were process measures and
135 were outcome measures. Consensus of two researchers (RJ and
BR) was used to map each measure into a matrix that encompassed
the three domains of nursing work and Donabedian’s quality model
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Table 1
Themes and keywords used in scoping review search.

Theme Keywords

EMR (Electronic medical record) electronic OR comp* OR auto* OR informat* record OR syst*
Nursing nurs* care
Healthcare health OR medic* communicat* “length of stay”
Benefit benefit OR adv* OR impact OR outcome
Medication medicat* OR ADE OR advers* OR drug* OR effect* OR error
Falls fall*
Pressure Injuries pressure AND injur* OR ulcer
Nutrition nutrit* OR diet
HAIs (Hospital-acquired infections) wound* OR CLABSI OR UTI sepsis OR septic delirium
VTE prophylaxis (Venous thromboembolism) VTE OR clot OR DVT OR PE OR prophylaxis

Fig. 1. PRISMA diagram of literature selection process.

(Donabedian, 1988), presented in Table 3. This matrix assisted with tribution and characteristics of nursing time on tasks (n = 10), and
identification of duplication and gaps in measures. nursing documentation (n = 13).

3.1.1. Nursing language

3.1. Structure measures
Structure measures typically included human and other
resources, organisational structures and the characteristics of work
and workflows (Donabedian, 1988). In this study the 24 structure
measures included use of a standard nursing language (n = 1), dis-
Using a standardised nursing language emerged as an impor-
tant consideration to consistently define nursing work and support
shared understanding of nurse work concepts across care settings
and electronic tools. A standard nursing language provides the
foundation to consistently capture fundamental nursing processes
(such as hygiene, nutrition) and harm prevention strategies (such

Please cite this article in press as: Jedwab, R. M., et al. Measuring nursing benefits of an electronic medical record system: A scoping
review. Collegian (2018), https://doi.org/10.1016/j.colegn.2019.01.003
 COLEGN-587; No. of Pages 21
G Model
review. Collegian (2018), https://doi.org/10.1016/j.colegn.2019.01.003
Please cite this article in press as: Jedwab, R. M., et al. Measuring nursing benefits of an electronic medical record system: A scoping

Table 2
Paper characteristics and measures.

Paper Citation Country Paper type Data Collection Timing Participants Discipline Stage of EMR Domain of nursing Measures Context
implementation work

Australian Council Australia Guideline N/A N/A All healthcare N/A Nursing Care Delivery Preventing harms of Australian healthcare
on Health Care professionals hospitalisation system
Standards (ACHS),
2010
Australian Institute Australia Guideline N/A N/A All healthcare N/A Nursing Care Delivery Preventing harms of Australian healthcare
of Health and professionals hospitalisation system
Welfare (AIHW),
2018
Akhu-Zaheya et al., Jordan Primary research Not specified 217 in paper group (1 Nursing Post-implementation Documentation Content and Hospital (medical and
2017 site), 217 in EHR group (2nd site) documentation surgical wards)
(2nd site)
Ali & Sieloff, 2017 USA Primary research Not specified 232 Nursing Not specified Documentation Standardised nursing Online
terminology within

ARTICLE IN PRESS
electronic health
records
Allen et al., 2014 USA Primary research Not specified Number not stated Nursing and Medical Post-implementation Hospital-acquired EMR-based Medical and surgical

R.M. Jedwab et al. / Collegian xxx (2018) xxx–xxx

infections documentation, intensive care units
barrier-compliance and
CLABSI rate
Amato et al., 2017 USA Primary research Not specified N/A Nursing, Medical and Post-implementation Medication Safety Types of medication Hospital
Pharmacy errors
Amland & USA Primary research Not specified N/A Nursing and Medical Post-implementation Hospital-acquired Sepsis detection 5 different medical
Hahn-Cover, 2016 infections centres
Asaro & Boxerman, USA Primary research Not specified Medical (11 pre- and Nursing and Medical Pre- and Communication Time spent on: using Hospital
2008 10 post-implementation computer, writing, care
post-implementation) planning, searching,
Nursing (13 pre- and retrieving results,
13 direct care, related
post-implementation) care, waiting
Australian Australia Guideline N/A N/A All heathcare N/A Nursing Care Delivery Preventing harms of Australian healthcare
Commission on professionals hospitalisation system
Safety and Quality
in Health Care
(ACSQHC), 2010
Australian Australia Guideline N/A N/A All heathcare N/A Nursing Care Delivery Preventing harms of Australian healthcare
Commission on professionals hospitalisation system
Safety and Quality
in Health Care
(ACSQHC), 2017a
Bardach et al., 2017 USA Primary resesarch Not specified 12 nurses, 5 certified All heathcare Post-implementation Communication Anecdotal use of the Hospital
nursing assistants, 2 professionals computer, searching,
pharmacists, 1 retrieving results,
occupational therapist, related care,
1 chaplain, 3 patient communication
care facilitators, 1
physical therapist, 1
physical therapy
assistant, 1 social
worker, 4 patient care
managers, 2 medical
students, 2 physicians
Barker, Gout, & Australia Review Not specified N/A All healthcare N/A Malnutrition Malnutrition screening Hospital
Crowe, 2011 professionals or assessment

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Table 2 (Continued)

Paper Citation Country Paper type Data Collection Timing Participants Discipline Stage of EMR Domain of nursing Measures Context
implementation work

Bates & Gawande, USA Review Not specified N/A All healthcare N/A Nursing Care Delivery Monitoring, accessing Hospital and
2003 professionals information, alerts and community
responding to clinical
deterioration
Baysari et al., 2016 Australia Primary research Not specified Nursing and Medical Nursing and Medical Post-implementation Deep Vein Thrombosis Electronic risk Hospital
clinicians assessment tool for VTE
Bingham, Fossum, Australia Primary research 1 day in September 422 patient events Nursing and Medical N/A Clinical Deterioration Clinical review criteria Hospital
Barratt, & Bucknall, 2013 documentation and
2015 escalation
Blackman et al., Australia Primary research Not specified 289 Nurses and Nursing and Midwifery N/A Missed Nursing Care Missed nursing care Hospital
2015 Midwives and rationales
Bond & Raehl, 2007 USA Database Not specified 2,836,991 patients in Nursing, Medical and N/A Medication Safety Medication Hospital
885 hospitals Pharmacy management,
education and

ARTICLE IN PRESS
mortality
Bragadottir, Iceland Primary research Not specified 864 Nurses Nursing N/A Missed Nursing Care Missed nursing care Hospital
Kalisch, & and rationales

R.M. Jedwab et al. / Collegian xxx (2018) xxx–xxx

Tryggvadottir,
2017
Brandt et al., 2015 USA Primary research Not specified N/A Nursing and Medical Post-implementation Hospital-acquired Sensitivity and Hospital
infections specificity of an
electronic sepsis
surveillance system
Brown et al., 2017 USA Review Not specified N/A Nursing and Medical Post-implementation Medication Safety Themes associated Hospital
with CPOE-related
prescribing errors
Brown et al., 2010 USA Primary research 2007 - 2008 196 hospitals Nursing N/A Nursing Care Delivery Pressure injuries and Hospital
falls with or without
injuries. Nursing care
indicators (hours, skill
mix, nurse/patient
ratios, workload
intensity, turnover,
patient minding) and
patient descriptors
(age, gender, and
diagnosis description)
Burns, Gallagley, & UK Review Not specified N/A All healthcare N/A Delirium Delirium Hospital and
Byrne, 2004 professionals community
Campanella et al., Italy Systematic review Not specified N/A All healthcare Pre- and Documentation Documentation time, Not specified
2016 and meta-analysis professionals post-implementation guideline adherence,
medication errors,
adverse drug events
and mortality
Chaudhry et al., USA Systematic review 2 searches -November N/A All healthcare Pre- and Documentation Qualitative, cost and Not specified
2006 2003 and January 2004 professionals post-implementation efficiency
Cho & Noh, 2010 South Korea Primary research Not specified 715 patients Nursing N/A Pressure Injuries Pressure injury Hospital – intensive
incidence care unit
Cho et al., 2013 South Korea Primary research Baseline 866 patients Nursing and Medical Post-implementation Pressure Injuries Pressure injury Hospital – intensive
group = 6-month incidence and length of care unit
period in 2006 – 2007, stay
intervention
group = 6-month
period in 2009 - 2010
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Paper Citation Country Paper type Data Collection Timing Participants Discipline Stage of EMR Domain of nursing Measures Context
implementation work

Cox, 2011 USA Primary research October 2008 - May 347 patients Nursing N/A Pressure Injuries Pressure injury Hospital – intensive
2009 incidence in critical care unit
care patients
Despins, 2017 USA Systematic review Not specified N/A Nursing and Medical Post-implementation Hospital-acquired Sepsis detection Not specified
infections
Dowding et al., USA Primary research 2003-2009 29 hospitals Nursing Pre- and Pressure Injuries Pressure injury and Hospital
2012 post-implementation falls risk assessments
and rates of incidences
Dunton et al., 2007 USA Review Not specified N/A Nursing N/A Falls Nursing care delivery Hospital
(total nursing hours per
patient day, percentage
of hours supplied by
RNs, and years of
experience in nursing)
Dunton et al., 2004 USA Primary research 2000 (Not specified N/A Nursing N/A Falls Falls, amount of Hospital

ARTICLE IN PRESS
further) nursing hours per
patient, skill mix and
presence of casual staff

R.M. Jedwab et al. / Collegian xxx (2018) xxx–xxx

Dykes & Collins, USA Review Not specified N/A Nursing N/A Nursing Care Delivery Falls, pressure injuries Not specified
2013 and patient experience
Forni et al., 2010 USA Review Not specified N/A Nursing and Medical N/A Medication Safety Medication errors, Hospital – intensive
computerized care unit
physician order entry
and clinical decision
support systems
Furukawa et al., USA Primary research Not specified 326 hospitals Nursing and Medical Pre- and Hospital Length of Stay Costs (discharges, Hospital
2010 post-implementation length of stay) and
nursing hours, skill mix
and pressure injuries,
failure to rescue
incidences, infections
and mortality (acute
myocardial infarction,
congestive heart failure
and pneumonia)
Garcia-Fernandez Spain Systematic review Not specified N/A Nursing and Medical N/A Pressure Injuries Pressure injury risk Hospital
et al., 2014Garcia- and meta-analysis assessments
Fernandez,
Pancorbo-Hidalgo,
& Agreda, 2014
Global eHealth Worldwide Guideline N/A N/A All heathcare Post-implementation Nursing Care Delivery Length of stay Hospital
Executive Council, professionals
2014
Gunningberg, Sweden Primary research 2002 and 2006 (not Pre = 357 patients, Nursing and Medical Pre- and Pressure Injuries Pressure injury Hospital
Dahm, & specified further) post = 343 patients post-implementation documentation
Ehrenberg, 2008
Gunningberg, & Sweden Primary research February 5, 2002 413 patients Nursing N/A Pressure Injuries Accuracy and quality of Hospital
Ehrenberg, 2004 pressure injury
documentation
Gunningberg et al., Sweden Primary research 2006 (Not specified Pre = 413 patients, Nursing Pre- and Pressure Injuries Quality and Hospital
2009 further) post = 343 patients post-implementation comprehensiveness of
pressure injury
documentation
Haines et al., 2013 Australia Review Not specified 1206 patients All heathcare N/A Falls Falls incidences, Hospital
professionals treatment and length
of stay

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Table 2 (Continued)

Paper Citation Country Paper type Data Collection Timing Participants Discipline Stage of EMR Domain of nursing Measures Context
implementation work

Hakes & USA Primary research July 2004 and July 2015 Pre = 220 nursing Nursing Pre- and Documentation Documentation time Hospital
Whittington, 2008 hours, post = 260 post-implementation
nursing hours
Harrison et al., USA Primary research Not specified 587 patients Nursing and Medical N/A Hospital-acquired Test for electronic Hospital
2015 infections sepsis detection
Hauck & Zhao, Australia Primary research 2005-2006 Approx 200,000 All healthcare N/A Nursing Care Delivery Adverse drug reaction, Hospital
2011 patient episodes professionals infection, pressure
injury
Haynes et al., 2011 USA Primary research 8 months (Not 2 hospitals Nursing, Medical and Post-implementation Hospital-acquired Adminsitration of Hospital
specified further) Pharmacy infections post-operative
antibiotics
Herasevich, Pieper, USA Primary research Not specified 1 hospital Nursing and Medical N/A Hospital-acquired Electronic sepsis Hospital
Pulido, & Gajic, infections detection
2011

ARTICLE IN PRESS
Hollenbeak, 2011 USA Review Not specified N/A Nursing, Medical and N/A Hospital-acquired Incidence and costs of Hospital
Pharmacy infections catheter-related
bloodstream infections

R.M. Jedwab et al. / Collegian xxx (2018) xxx–xxx

Hooper & Jacobs, USA Review Not specified N/A Nursing and Medical Post-implementation Hospital-acquired Sepsis and length of Hospital
2009 infections stay
Hoover, 2016 USA Review Not specified N/A All heathcare Post-implementation Medication Safety Legibility, medication Hospital
professionals safety, patient
experience, nurse
experience
Hope et al., 2014 USA Primary research 1 December 2009 – 31 Not specified total Nursing, Medical and Post-implementation Delirium Documentation of Hospital
May 2010 screened, n = 25 for Pharmacy delirium
delirium
Inacio et al., 2011 USA Primary research Not specified Patients who Medical Post-implementation Hospital-acquired Incidence of surgical Hospital
underwent a total joint infections site infection
replacement between
January 2006 and
December 2008
Jayawardena et al., USA Primary research January 2004 to 466,311 medication Nursing, Medical and Post-implementation Medication Safety Medication errors Hospital
2007 January 2005 prescriptions Pharmacy (wrong dosage
adjustment for
creatinine clearance,
duplicate orders,
incorrect orders,
allergy status,
incomplete orders)
Jheeta & Franklin, UK Primary research Not specified Pre = 428 observations, Nursing, Medical and Pre- and Medication Safety Medication errors Hospital
2017 post = 528 observations Pharmacy post-implementation (administration and
documentation)
Jin, Piao, & Lee, South Korea Primary research Not specified 5932 patients Nursing Post-implementation Pressure Injuries Risk assessment for Hospital
2015 pressure injuries
Johnson et al., 2012 Australia Primary research Not specified 195 patient handovers Nursing N/A Communication Quality and content of Hospital and
communication community
Jones, Hamilton, & USA Review Not specified 14 self-report Nursing N/A Missed Nursing Care Nursing care (missed, Hospital
Murry, 2015 instruments unfinished and
prioritization)
Kaewprag et al., USA Primary research Not specified 7717 patients Nursing Post-implementation Pressure Injuries Pressure injury risk Hospital – intensive
2017 factors and assessment care unit
Kahn et al., 2012 USA Guideline N/A N/A Nursing, Medical and N/A Deep Vein Thrombosis VTE risk assessment Hospital
Pharmacy
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Table 2 (Continued)

Paper Citation Country Paper type Data Collection Timing Participants Discipline Stage of EMR Domain of nursing Measures Context
implementation work

Kalisch, Tschannen, USA Primary research Not specified 11 hospitals Nursing N/A Missed Nursing Care Missed nursing care, Hospital
& Lee, 2012 nursing hours per
patient, falls,
Keenan et al., 2013 USA Primary research Not specified 200 hours of Nursing N/A Communication Nurse communication Hospital
observations and documentation
Khan et al., 2015 USA Primary research Not specified 92 patients Nursing and Medical N/A Delirium Delirium diagnosis, Hospital
mortality, readmission,
risk screening and
length of stay
Khurana et al., USA Primary research 29 April 2011 until 30 312,214 patients across Nursing and Medical Post-implementation Hospital-acquired Incidences of sepsis, Hospital
2016 June 2013 24 hospitals infections length of stay,
mortality
Kurczewski, Sweet, USA Primary research Before = July 2012 to West Virginia Nursing and Medical Post-implementation Hospital-acquired Sepsis interventions Hospital
McKnight, & September 2012, University (WVU) (pre- and post-alert infections

ARTICLE IN PRESS
Halbritter, 2015 after = January 2013 to Hospitals in 2012 activation)
March 2013 (Further details not
specified)

R.M. Jedwab et al. / Collegian xxx (2018) xxx–xxx

Lake et al., 2010 USA Primary research 2004 data obtained in 108 Magnet and 528 Nursing N/A Falls Falls, Nursing hours per Hospital
2006 non-Magnet hospitals patient
Leonard et al., 2004 USA Review N/A Large, non-profit All heathcare N/A Communication Communication and Hospital
American health professionals teamwork (briefings,
system transfers)
Li & Korniewicz, USA Primary research Not specified 139 patients Nursing Post-implementation Pressure Injuries Pressure injury risk Hospital
2013 assessment
completion, occurences
of pressure injuries and
quality of pressure
injury documentation
Lim et al., 2012 Singapore Primary research February - November 818 patients Nursing and Medical N/A Malnutrition Nutrition assessment, Hospital
2006 malnutrition, length of
stay, readmission and
mortality
Liu, Luo, Zhang, & China Systematic review Not specified N/A Nursing and Medical Post-implementation Nurse and Patient Patient satisfaction Hospital
Huang, 2013 Experience
Lo et al., 2013 Taiwan Primary research Training = 1 March – 30 Training = 8308 Nursing and Medical Post-implementation Hospital-acquired Incidence of Hospital
June 2009, Testing = 1 patients, infections healthcare-associated
July - 31 October 2009 Testing = 11,251 urinary tract infection
patients
Manaktala & USA Primary research 1 March – 31 2 hospitals Nursing and Medical Post-implementation Hospital-acquired Sepsis, mortality and Hospital
Claypool, 2017 December 2014 infections readmissions
Marier, Olsho, USA Primary research 5 October 2011 – 22 5129 residents in 13 Nursing and Medical Post-implementation Falls Falls and falls risk Nursing homes
Rhodes, & Spector, April 22 2014 nursing homes factors
2016
Mattison et al., USA Primary research Baseline – 1 July 1 – 30 1 hospital Nursing and Medical Post-implementation Medication Safety Medication prescribing Hospital
2010 November 2004, (pre- and post-alert
Testing March 2004 - activation)
31 August 2008
McRee et al., 2014 USA Primary research Not specified 171 patients (75 Nursing and Medical Post-implementation Hospital-acquired Sepsis, length of stay, Hospital
pre-alert, 96 post-alert) (pre- and post-sepsis infections mortality, discharge
alert activation) destination
Miller et al., 2017 USA Primary research 3-week period 32 Nurses in 2 critical Nursing N/A Pressure Injuries Pressure injury Hospital
care units knowledge and
prevention

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Table 2 (Continued)

Paper Citation Country Paper type Data Collection Timing Participants Discipline Stage of EMR Domain of nursing Measures Context
implementation work

Miller et al., 2016 USA Primary research Admissions during 230 patients Nursing N/A Pressure Injuries Pressure injury risk Hospital
2011 assessment, incidence
and risk factors and
nutritional status
Moon et al., 2018 South Korea Primary research Baseline September Baseline = 3284, Nursing Post-implementation Delirium Delirium incidences Hospital – intensive
2009 – April 2012, External (pre- and and risk factors care unit
External validation validation = 325, 3 post-automated
May 2012 – July 2012, months post- delirium risk
3 months implementation = 263, assessment)
post-implementation 1 year post-
November 2013 – implementation = 431
January 2014, 1 year

ARTICLE IN PRESS
post-implementation
August 2014 –
December 2014

R.M. Jedwab et al. / Collegian xxx (2018) xxx–xxx

Narayanan et al., USA Primary research Control = March 2012 - Adult patients with Nursing and Medical Post-implementation Hospital-acquired Sepsis, time to Hospital
2016 October 2012, severe (pre- and post-sepsis infections antibiotics, mortality,
intervention = January sepsis and septic shock alert) length of stay
2013 - July 2013 in the ED
Nebeker, 2002 USA Review N/A N/A Nursing and Medical Post-implementation Medication Safety Medication errors, Hospital and
adverse drug events community
Nguyen et al., 2014 USA Primary research 1 January – 31 March 1095 patients Nursing and Medical Post-implementation Hospital-acquired Sepsis alerts, false Hospital – emergency
2012 infections positive and false department
negative alerts and
type of infections
(cause)
Nursing & Australia Guideline N/A N/A Nursing and Midwifery N/A Nursing Care Delivery Foundations of care Australian healthcare
Midwifery Board of and patient-specific system
Australia, 2016 care
O’Tuathail & Taqi, UK Review Not specified N/A Nursing N/A Pressure Injuries Pressure injury risk Hospital and
2011 assessments, community
prevention,
management and
education
Oh et al., 2014 South Korea Primary research Baseline = January - Baseline = 724, Nursing and Medical Post-implementation Delirium Delirium incidences, Hospital – intensive
December 2010, intervention = 1111 (pre- and post-delirium risk factors and care unit
intervention = May patients risk alert) interventions
2011 - April 2012
Olenick et al., 2017 USA Primary research Patients who had 12 hospitals Nursing and Medical Post-implementation Hospital-acquired Sepsis incidences Hospital
hospital admission and (pre- and post-sepsis infections
discharge during year detection algorithm)
2013
Ortega et al., 2008 Spain Primary research Phase I = April 2004 - 1 hospital Nursing, Medical and Post-implementation Medication Safety Adverse drug reaction Hospital
August 2006, Phase Pharmacy (pre- and post-adverse
II = September 2006 - drug reaction
April 2007 reporting)
Osheroff et al., USA Review N/A N/A Nursing, Medical and N/A Nurse and Patient Clinical decision Hospital
2007 Pharmacy Experience support, experience
and use
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Paper Citation Country Paper type Data Collection Timing Participants Discipline Stage of EMR Domain of nursing Measures Context
implementation work

Pageler et al., 2014 USA Primary research Baseline = June 2009 - 24-bed unit Nursing and Medical Post-implementation Hospital-acquired CLABSI rate, Hospital – intensive
30 April 2011, infections central-line care unit
intervention = 1 documentation,
September 2011 – 31 compliance with
December 2012 dressing, cap and port
changes and insertion
kit
Paul & Robinson, Australia Review N/A N/A Nursing and Medical Post-implementation Medication Safety Adverse drug events, Hospital
2012 communication and
documentation
Piscotty, Kalisch, USA Primary research Autumn 2014 124 Nurses Nursing Post-implementation Missed Nursing Care Missed nursing care Hospital
Gracey-Thomas, & reminders
Yarandi, 2015
Plaskitt et al., 2015 UK Primary research Not specified Nurses (no further Nursing Post-implementation Pressure Injuries Pressure injuy risk and Hospital
information specified) occurence

ARTICLE IN PRESS
Ray, Laur, & UK Review N/A N/A All healthcare N/A Malnutrition Incidences of Hospital and
Golubic, 2014 professionals malnutrition community
Redley & Raggatt, Australia Primary research 2015 11 health services Nursing N/A Nursing Care Delivery Number of risk Hospital and

R.M. Jedwab et al. / Collegian xxx (2018) xxx–xxx

2017 assessments, community
interventions and
duplication
Roberts et al., 2010 USA Primary research May 2003 - March 1 health organisation Nursing, Medical and Post-implementation Medication Safety Adverse drug events Hospital
2006 comprised of 44 Pharmacy (post-alert
hospitals implementation
Rossi et al., 2014 Australia Primary research 12 months (not further 56 dialysis patients All healthcare Post-implementation Malnutrition Dietician time with Hospital
specified) professionals patient and number of
nutrition-related
diagnoses in EMR
Rothman et al., USA Primary research Not specified 258836 inpatient Nursing and Medical Post-implementation Hospital-acquired Sepsis identification Hospital
2017 records from 4 infections and prediction
hospitals
Rudolph et al., USA Primary research Retrospective = October Retrospective = 27,625 Nursing and Medical Post-implementation Delirium Delirium, risk Hospital
2016 2012 - September medical records of screening, length of
2013, hospitalized patients, stay and discharge
Prospective = January Prospective destination
2013 - patients = 246
March 2014
Runciman et al., Australia Primary research Not specified N/A All healthcare N/A Documentation Concepts and Hospital and
2009 professionals definitions of clinician community
documentation
Saum & Reeves, USA Primary research Pre-implementation = 1 Pre- Medical Pre- and Deep Vein Thrombosis VTE prophylaxis Hospital
2016 November 2011 - 31 implementation = 1171, post-implementation prescriptions, risk
December 2011, post- post- factors and
implementation = 1 implementation = 1252 contraindications
November 2012 – 31 patients
December 2012
Seidling et al., 2007 Germany Primary research Not specified 1 hospital Medical Post-implementation Medication Safety Medication Hopsital
prescriptions with dose
limits exceeded
Seidling et al., 2010 Germany Primary research Phase 1 = baseline 1 hospital Medical Post-implementation Medication Safety Medication Hospital
(date not specified), (pre- and post-alert prescriptions
Phase 2 = intervention implementation)
July - October 2008
Siddiqi & House, UK Review N/A N/A Nursing, Medical and N/A Delirium Delirium risk factors, Hospital and
2006 Pharmacy measures causes and community
investigations

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Table 2 (Continued)

Paper Citation Country Paper type Data Collection Timing Participants Discipline Stage of EMR Domain of nursing Measures Context
implementation work

Smith et al., 2006 USA Primary research 1 October 1999 -31 Outpatients Nursing, Medical and Post-implementation Medication Safety Medication Hospital
December 2002 Pharmacy (pre- and post-alert prescriptions
(includes 12 months implementation)
pre-alert
implementation and 27
months
post-implementation
Stalpers, de The Systematic review Not specified N/A Nursing N/A Nurse-Sensitive Nurse education, Hospital
Brouwer, Kaljouw, Netherlands Outcomes experience and staffing
& Schuurmans, hours and falls,
2015 pressure injuries and

ARTICLE IN PRESS
communication
Stevenson & Sweden Primary research 2-week period 21 Nurses Nursing Post-implementation Nurse and Patient Nurse satisfaction with Hospital
Nilsson, 2012 November - December Experience EMR documentation

R.M. Jedwab et al. / Collegian xxx (2018) xxx–xxx

2008 for observations,
medications and
overviews
Stevenson et al., Sweden Review 1st search = February - N/A Nursing Post-implementation Nurse and Patient Nurse satisfaction with Hospital
2010 April 2008, 2nd Experience EMR documentation
search = March 2009
Stockton et al., Canada Primary research 1 October 2014 - 31 1 hospital Nursing, Medical and N/A Medication Safety Medication errors Hospital
2017 August 2015 Pharmacy
Sutcliffe et al., 2004 USA Primary research 1999 26 Medical residents Nursing and Medical N/A Communication Communication factors Hospital
and patient
management or
incidences
Swan et al., 2011 USA Primary research Not specified 15 Nurses Nursing Post-implementation Delirium Computer proficiency, Hospital
delirium screening
tools, knowledge and
attitude of older adult
patients and CAM tool
knowledge
Taylor et al., 2014 USA Primary research Basline = August 2011, Basline = 75 patient- Nursing and Medical Pre- and Communication Frequency of Hospital
Post- nurse-physician triads, post-implementation nurse-physician
intervention = Ausgust Post- communication, Total
2012 implementation = 123 Agreement Score and
triads patient prediction of
expected length of stay
Tescher, Branda, USA Primary research 1 January 2007 – 31 12566 patients Nursing N/A Pressure Injuries Pressure injury risk Hospital
Byrne, & Naessens, December 2007 assessment score,
2012 incidence and patient
clinical condition
Thompson, O’Horo, USA Systematic review Not specified N/A Nursing, Medical and Post- implementation Nursing Care Delivery Mortality, cost of care Hospital
Pickering, & and meta-analysis Pharmacy and length of stay
Herasevich, 2015
Tornvall, Sweden Primary research December 2002 – 212 nurses Nursing and Medical Post- implementation Documentation Documentation Community
Wilhelmsson, & February 2003 components, frequency
Wahren, 2004 and quality
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Table 2 (Continued)

Paper Citation Country Paper type Data Collection Timing Participants Discipline Stage of EMR Domain of nursing Measures Context
implementation work

Tsai & Kong, 2013 Australia Primary research Not specified 4 healthcare All healthcare Post-implementation Nurse and Patient Knowledge of Hospital and
organisations professionals Experience processes and use of community
technology
Tubaishat et al., Jordan Primary research Not specified Electronic = 43, Nursing Post-implementation Pressure Injuries Pressure injury Hospital

ARTICLE IN PRESS
2015 Paper = 39 patients documentation
completeness and

R.M. Jedwab et al. / Collegian xxx (2018) xxx–xxx

accuracy
Verrall et al., 2015 Australia Primary research 1 November - 31 Survey = 354, Nursing N/A Missed Nursing Care Nursing staff numbers Hospital
December 2012 qualittative = and skill mix
Ward et al., 2014 USA Primary research 15 May 2011 – 26 Patient emergency Nursing and Medical Pre- and Nursing Care Delivery Length of stay, Hospital
November 2011 department post-implementation satisfaction
presentations
Weiss, Yakusheva, USA Primary research January – July 2008 1,892 patients Nursing N/A Missed Nursing Care Nursing staff, discharge Hospital
& Bobay, 2011 education and patient
representing to
emergency department
Whitman et al., USA Primary research Not specified 95 units across 10 Nursing N/A Nursing Care Delivery Nurse staffing and Hospital
2002 hospitals central line infections,
falls, pressure injuries,
restraint use and
medication errors
Witlox et al., 2010 The Systematic review Not specified N/A All healthcare N/A Delirium Delirium incidences, Hospital
Netherlands and meta-analysis professionals risk factors and patient
outcomes
Wright et al., 2011 USA Primary research Not specified 5 healthcare All healthcare Post-implementation Nursing Care Delivery Clinical decision Hospital and
organisations professionals support governance community
Wright et al., 2009 USA Primary research Not specified 9 EMR programs All healthcare Post-implementation Nursing Care Delivery Alert types and Hospital
professionals escalation variation
Zhang, Holman, Australia Primary research 1980–2003 37296 patients Nursing, Medical and N/A Medication Safety Adverse drug reactions Hospital
Preen, & Brameld, screened Pharmacy and reshopitalisation
2007

EHR = Electronic Health RecordN/A = Not Applicable.

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Table 3
Included Structure, Process and Outcome measures for each Nursing domain.
Structure
Fundamentals of care Nursing & Midwifery Board of
Australia, 2016
Documentation Akhu-Zaheya et al., 2017
Ali & Sieloff, 2017
Campanella et al., 2016
Chaudhry et al., 2006
Redley & Raggatt, 2017
Runciman et al., 2009
Tornvall, Wilhelmsson, & Wahren,
2004
Communication
Nursing Care Delivery Bates & Gawande, 2003
Wright et al., 2011
Wright et al., 2009
Preventing harms of hospitalisation Australian Council on Health Care
Standards (ACHS), 2010
Australian Institute of Health and
Welfare (AIHW), 2018
Australian Commission on Safety
and Quality in Health Care
(ACSQHC), 2010
Medication Safety
Hospital-acquired infections
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Process
Asaro & Boxerman, 2008
Bardach et al., 2017
Taylor et al., 2014
Keenan et al., 2013
Leonard et al., 2004
Paul & Robinson, 2012
Pageler et al., 2014
Rothman et al., 2017
Outcome
Hakes & Whittington, 2008
Johnson et al., 2012
Sutcliffe et al., 2004
Taylor et al., 2014
Blackman et al., 2015
Bragadottir, Kalisch, & Tryggvadottir, 2017
Brown et al., 2010
Dykes & Collins, 2013
Hauck & Zhao, 2011
Jones, Hamilton, & Murry, 2015
Kalisch, Tschannen, & Lee, 2012
Piscotty, Kalisch, Gracey-Thomas, & Yarandi, 2015
Stalpers, de Brouwer, Kaljouw, & Schuurmans, 2015
Thompson et al., 2015
Verrall et al., 2015
Ward et al., 2014
Weiss, Yakusheva, & Bobay, 2011
Whitman et al., 2002
Australian Commission on Safety and Quality in Health
Care (ACSQHC), 2010
Australian Commission on Safety and Quality in Health
Care (2017a)
Amato et al., 2017
Bond & Raehl, 2007
Brown et al., 2017
Forni et al., 2010
Hoover, 2016
Jayawardena et al., 2007
Jheeta & Franklin, 2017
Mattison et al., 2010
Nebeker, 2002
Ortega et al., 2008
Paul & Robinson, 2012
Roberts et al., 2010Seidling et al., 2007
Seidling et al., 2010
Smith et al., 2006
Stockton et al., 2017
Zhang, Holman, Preen, & Brameld, 2007
Allen et al., 2014
Amland & Hahn-Cover, 2016
Brandt et al., 2015
Despins, 2017
Harrison et al., 2015
Haynes et al., 2011
Herasevich, Pieper, Pulido, & Gajic, 2011
Hollenbeak, 2011
Hooper & Jacobs, 2009
Inacio et al., 2011
Khurana et al., 2016
Kurczewski, Sweet, McKnight, & Halbritter, 2015
Lo et al., 2013
Manaktala & Claypool, 2017
McRee et al., 2014
Narayanan et al., 2016
Nguyen et al., 2014
Olenick et al., 2017
Pageler et al., 2014
Rothman et al., 2017
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Table 3 (Continued)

Structure Process Outcome

Deep Vein Thrombosis Baysari et al., 2016

Kahn et al., 2012
Saum & Reeves, 2016
Clinical Deterioration Bingham, Fossum, Barratt, & Bucknall, 2015
Delirium Burns, Gallagley, & Byrne, 2004
Hope et al., 2014
Khan et al., 2015
Moon et al., 2018
Oh et al., 2014
Rudolph et al., 2016
Siddiqi & House, 2006
Swan et al., 2011
Witlox et al., 2010
Pressure injuries Cho & Noh, 2010
Cho et al., 2013
Cox, 2011
Dowding et al., 2012
Garcia-Fernandez, Pancorbo-Hidalgo, & Agreda, 2014
Gunningberg, Dahm, & Ehrenberg, 2008
Gunningberg & Ehrenberg, 2004
Gunningberg et al., 2009
Jin, Piao, & Lee, 2015
Kaewprag et al., 2017
Li & Korniewicz, 2013
Miller et al., 2017
Miller et al., 2016
O’Tuathail & Taqi, 2011
Plaskitt et al., 2015
Tescher, Branda, Byrne, & Naessens, 2012
Tubaishat et al., 2015
Falls Dunton et al., 2007
Dunton et al., 2004
Haines et al., 2013
Lake et al., 2010
Marier, Olsho, Rhodes, & Spector, 2016
Malnutrition Barker, Gout, & Crowe, 2011
Lim et al., 2012
Ray, Laur, & Golubic, 2014
Rossi et al., 2014
Length of Stay Furukawa et al., 2010
Global eHealth Executive Council, 2014
Condition-specific care Nursing & Midwifery Board of
Australia, 2016
Experience and satisfaction Osheroff et al., 2007 Osheroff et al., 2007 Liu, Luo, Zhang, & Huang, 2013
Tsai & Kong, 2013 Tsai & Kong, 2013 Osheroff et al., 2007
Stevenson & Nilsson, 2012
Stevenson et al., 2010
Tsai & Kong, 2013

as strategies to prevent pressure injury and falls) in nursing docu-
mentation (Johnson, Jefferies, & Nicholls, 2012). Proposed benefits
of using a standard nursing language in an EMR include support for
care quantification, benchmarking, and research capabilities (Ali &
Sieloff, 2017; Runciman et al., 2009; Saranto et al., 2014). Identify-
ing a standard nursing language suitable for the Australian context
was beyond the scope of this review and provides a focus for further
study.
3.1.2. Nurse work-time distribution
The structure of nursing work has been examined using the
duration and distribution of time spent on nursing activities,
patterns in nurses’ work and workflows. Studies have typically
examined broad categories of nursing work such as: direct patient
care (for example, at the bedside, fundamental nursing activi-
ties such as observations, hygiene, wound care, and medication
management), indirect patient care (such as administrative bur-
den, completing standard risk and assessment forms, non-nursing
services and equipment gathering) and other categories (such
as interruptions, multitasking and waste) (Chaboyer et al., 2008;
Duffield, Gardner, & Catling-Paull, 2008; VanFosson, Jones, & Yoder,
2016). In addition, studies have also examined nurses’ time spent
on specific tasks expected to be impacted by electronic systems. For
example, nursing time using paper documents or a computer have
often been used to measure change when introducing electronic
systems (Liu et al., 2018; Park, Blegen, Spetz, Chapman, & De Groot,
2015).
Studies that measured the impacts of technology on nursing
work in relation to the quantity, frequency and/or duration of time
nurses spend on direct and indirect patient care report inconsistent
findings (Asaro & Boxerman, 2008; Callen et al., 2013; Liu et al.,
2018; Park et al., 2015). This is likely impacted by limitations such
as inconsistent or unclear classifications or categories of nursing
work across the studies, variability in the measurement methods
and tools (for example, continuous versus intermittent data cap-
ture; direct observation versus self-report) and the way data are
reported (for example, proportion of nurse work time versus dura-
tion in minutes).
3.1.3. Nursing documentation
Data to examine nursing documentation was most often cap-
tured using the time nurses spend working on care records. Studies
reporting impacts of implementing an EMR system on nursing
documentation were inconsistent. For example, a meta-analysis

Please cite this article in press as: Jedwab, R. M., et al. Measuring nursing benefits of an electronic medical record system: A scoping
review. Collegian (2018), https://doi.org/10.1016/j.colegn.2019.01.003
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by Campanella et al. (2016) reported a decrease in nurses’ time
spent on documentation after introducing electronic documen-
tation. Alternatively, an earlier paper by Chaudhry et al. (2006)
identified two studies reporting a decrease in nursing documen-
tation time with an electronic system, and one study that found no
change.
Data about the quantity, quality and timeliness of nursing
documentation, identified as important in professional standards
(Australian Commission on Safety & Quality in Health Care, 2017a;
Nursing & Midwifery Board of Australia, 2016), were infrequently
captured. A study comparing electronic and paper nursing doc-
umentation at two hospital sites reported introducing electronic
records improved the structure and processes for nursing docu-
ments; however the quantity and quality of nursing documentation
was superior in paper records (Akhu-Zaheya, Al-Maaitah, & Bany
Hani, 2017). One Australian study reported nursing assessment
documentation improved in the EMR, but not timeliness (Wang,
Yu, & Hailey, 2013). Benefits of electronic documentation have been
attributed to structures that support automated author identifi-
cation, time stamping, increased legibility, contemporaneous and
chronological-order information inputs (that are consistent with
requirements of the Healthcare Information and Management Sys-
tems Society (HIMSS) standards) (Chand & Sarin, 2014).
3.2. Process measures
Process measures included factors that facilitated outcomes of
care delivery (Donabedian, 1988). In this study, nine process mea-
sures captured the workflows involved in delivering nursing care.
In particular, measures of communication between nurses and the
healthcare team emerged as a key factor impacted by EMR imple-
mentation.
3.2.1. Communication
Examination of communication activities such as face-to-face
interactions, telephone calls and accessing information often used
duration and frequency to draw conclusions about the impact of
technology on nurse communication practices. Timely and effective
communication between multi-disciplinary team members and
the patient has been associated with improved patient outcomes
(Bardach, Real, & Bardach, 2017; Leonard, Graham, & Bonacum,
2004; Sutcliffe, Lewton, & Rosenthal, 2004). A wide range of changes
in intra- and inter-professional communication patterns between
healthcare staff was also reported. For example, nurses were found
to spend less time in face-to-face communication with other
healthcare professionals after EMR implementation (Keenan, Yakel,
Dunn Lopez, Tschannen, & Ford, 2013; Taylor, Ledford, Palmer, &
Abel, 2014). A gap in the availability of measures to capture the
quality and effectiveness of nurse communication processes with
EMR implementation was identified.
3.3. Outcome measures
Outcome measures captured the consequences of care delivery
(Donabedian, 1988) and were the most prevalent measures identi-
fied in this review (n = 135). Identified outcome measures included
missed nursing care (n = 27), preventable patient harms sensitive to
nursing care quality (n = 102), length of stay (n = 1) and experience
and satisfaction (n = 5).
3.3.1. Missed nursing care
Perceptions of missed nursing care has been used as a proxy
outcome indicator for the quality of nursing care (Griffiths et al.,
2017), but has not yet been examined in the specific context of
EMR implementation.
Please cite this article in press as: Jedwab, R. M., et al. Measuring nursing benefits of an electronic medical record system: A scoping
review. Collegian (2018), https://doi.org/10.1016/j.colegn.2019.01.003
3.3.2. Preventable patient harms and complications
Nurse-sensitive patient safety outcomes such as rates of falls
and pressure injuries were frequently used to measure nursing
care quality (Dunton, Gajewski, Taunton, & Moore, 2004; Dunton,
Gajewski, Klaus, & Pierson, 2007; Lake, Shang, Klaus, & Dunton,
2010). One study suggested implementing an EMR system can
directly influence multiple patient safety outcomes impacted by
nursing care, for example, the number of falls and pressure injury
incidences (Dowding, Turley, & Garrido, 2012.
• Medication safety
A reduction in medication errors was commonly reported as
a patient safety outcome of introducing electronic information
systems. A number of studies reported that EMR systems with elec-
tronic medication management components, such as alerting and
clinical decision support, could reduce the frequency of some errors
(for example, missed dose, erroneous dosing, duplication, prescrib-
ing and administration) and eliminate others (such as handwriting
interpretation, exceeding dose limits) (Amato et al., 2017; Brown
et al., 2017; Campanella et al., 2016; Forni, Chu, & Fanikos, 2010;
Hoover, 2016; Jheeta & Franklin, 2017; Mattison, Afonso, Ngo, &
Mukamal, 2010; Nebeker, 2002; Roberts et al., 2010; Seidling et al.,
2007, 2010; Smith et al., 2006).
• Hospital-acquired infections
EMR systems with automated algorithms have been successfully
used to identify incidences of infections or sepsis, and provide clin-
ician support for early detection and treatment (Allen et al., 2014;
Lo, Lee, & Liu, 2013; Pageler et al., 2014).
• Deep vein thrombosis
Implementation of EMR systems has been associated with
reduced rates of deep vein thrombosis, and increased compliance
with risk assessment and prophylaxis processes (Baysari et al.,
2016; Saum & Reeves, 2016).
• Clinical deterioration
Measures of clinical deterioration such as rates of clinical esca-
lation and cardiac arrests have been successfully measured and
monitored using EMR systems (Osheroff et al., 2007; Wright et al.,
2009, 2011). However, measurement of benefits for nurses’ roles in
the documentation of clinical risk, detection or escalation responses
to patient deterioration is lacking.
• Delirium
Introduction of an EMR has been shown to improve documen-
tation of delirium outcome measures such as risk identification,
assessment, management and implementation of nursing inter-
ventions (Moon, Jin, Jin, & Lee, 2018; Oh, Park, Jin, Piao, & Lee,
2014; Rudolph, Doherty, Kelly, Driver, & Archambault, 2016; Swan,
Becker, Rickie Brawer, & Sciamanna, 2011).
• Pressure injuries
Reporting of the incidence of pressure injury, compliance
with risk assessment, and implementation of interventions for
pressure injury prevention are common outcome measures of
EMR implementation (Australian Commission on Safety & Quality
in Health Care, 2017a). Reports of increased rates of hospital-
acquired pressure injuries with EMR implementation have been
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attributed to improved reporting and completion of risk assess-
ments by nurses (Gunningberg, Fogelberg-Dahm, & Ehrenberg,
2009; Plaskitt, Heywood, & Arrowsmith, 2015).
• Falls
Consistent with findings of increased reporting of pressure
injuries with EMR implementation, falls outcome measures such
as reporting of incidence, compliance with completion of risk
assessments and implementation of preventative interventions
have similarly increased with EMR implementation (Australian
Commission on Safety & Quality in Health Care, 2017a).
• Malnutrition
In one study, introducing an EMR improved the efficiency and
effectiveness of identifying patients’ nutritional deficits (Rossi,
Campbell, & Ferguson, 2014).
3.3.3. Length of stay
Reports of the impacts of implementing an EMR system on hos-
pital length of stay (LOS) is variable (Thompson, O’Horo, Pickering,
& Herasevich, 2015). Two studies reported increased patient LOS
after implementation of an EMR system (Furukawa, Raghu, & Shao,
2010; Ward, Froehle, Hart, Collins, & Lindsell, 2014); however,
Furukawa et al. (2010) reported the increase returned to pre-
implementation baseline approximately eight weeks later. This
finding suggests the impact of EMR on LOS may vary over the
stages of implementation, hence hospital LOS should be viewed
cautiously as an early outcome measure of EMR implementation.
This parameter may be best evaluated over the long term.
3.3.4. Experience and satisfaction
Reports of nurses’ experiences and satisfaction with EMRs are
mixed. For example, studies by Harmon, Fogle, and Roussel, (2015)
and Takian, Sheikh, and Barber, (2012) found that nurses’ attitudes
towards the EMR were more positive 3–5 years post-EMR imple-
mentation, whilst Stevenson, Nilsson, Petersson, and Johansson
(2010)’s review reported that nurses were dissatisfied with EMR
systems as they felt they did not support clinical practice. Interest-
ingly, Kossman and Scheidenhelm (2008) reported that although
nurses preferred the efficiency and accessibility of information in
an EMR system, it hindered inter-disciplinary communication and
was time-consuming to use. These mixed findings can be due to
inconsistent tools, timeframes and measurement methods used. A
gap in measurement of patient experiences of EMR implementation
was identified.
4. Discussion
This scoping review identified 168 potentially useful measures
to evaluate the impact of implementing an EMR on the quality
and safety of nursing work in Australian hospitals. These measures
captured two out of the three nursing care domains examined.
While measures that examine the delivery of fundamental nurs-
ing care needs and preventing avoidable harms were frequently
identified, there was a gap in how to examine if nursing care is
patient-centred and delivered in partnership with the patient and
care team (Nursing & Midwifery Board of Australia, 2016). Simi-
larly, while several measures captured structures and outcomes of
nursing work, there were limited measures relevant to capturing
the processes of nursing work.
Structure measures predominantly examined nursing work-
time distribution, documentation and use of standard language;
however the findings of this review suggest examination of these
Please cite this article in press as: Jedwab, R. M., et al. Measuring nursing benefits of an electronic medical record system: A scoping
review. Collegian (2018), https://doi.org/10.1016/j.colegn.2019.01.003
17
measures should be undertaken in conjunction with examining
nursing time spent on care activities, to identify how any released
time is spent. The presumption in some studies that increased
nursing documentation time is an unnecessary clinical burden
may need to be reconsidered (Keenan et al., 2013; Kim, Coiera,
& Magrabi, 2017) particularly if EMR implementation is associ-
ated with improved quality of nurse documentation and facilitates
increased time with patients, and subsequent improved patient
care outcomes. Duration of nurse time spent on documentation
should be cautiously used as an independent measure of EMR
impact on nurses’ work.
The quality of communication between nurses and the broader
healthcare team has often been associated with preventable patient
harms (Australian Commission on Safety & Quality in Health Care,
2017a; Duckett et al., 2018). Examinations of nurse communica-
tion were limited in this review, and most often focussed on nurse
time spent with patients as a proxy measure of communication
with patients. As primary caregivers, nurses play a central role in
ensuring the effective intra- and inter-disciplinary communication
required for ongoing patient care. It is recognised that EMR systems
have complex influences on nurse communication, but potential
risks or benefits are not well measured in current literature, high-
lighting a gap in available measures (Hripcsak, Vawdrey, Fred, &
Bostwick, 2011).
Outcome measures were comprehensively captured in this
review; however, it is difficult to attribute many outcomes to direct
nursing benefits of an EMR system implementation due to poor
process measures. For example, identification of risk, compliance
with risk assessment completion, and initiation and evaluation of
preventative interventions were identified as vital components to
the success of an outcome measures, but their evaluation in EMR
implementation was inconclusive.
The measures identified in this review were variable, with lim-
ited evidence available for the relevance of many to expected
nursing care benefits of EMR implementation. These findings are
comparable to other syntheses of EMR literature to examine the
quality of available evidence and contextual challenges faced with
EMR adoption (Eden, Burton-Jones, Scott, Staib, & Sullivan, 2017).
This literature has highlighted the importance of close monitor-
ing of EMR implementation using valid and reliable measures
to detect unintended consequences on decision-making and sub-
sequent effects on patient care (Bardach et al., 2017; Bates &
Gawande, 2003).
The suite of indicators identified in the review (see Tables 2 and
3) may provide a broad evaluation and monitoring plan specific to
the nursing benefits of EMR implementation. These indicators cap-
ture many key activities that can be examined before and after EMR
implementation, to evaluate both structure and process changes
associated with EMR implementation. The measures can be opera-
tionalised across three organisational tiers:
1 Ward and local clinical governance: to monitor and evaluate the
quality of direct nursing care, assessments and interventions.
2 Nursing-profession evaluation: specific processes to monitor
nursing professional standards, codes and guidelines.
3 Organisational processes: EMR nursing-specific goals align with
many National Safety and Quality Health Service Standards
(Australian Commission on Safety & Quality in Health Care,
2017a) and healthcare quality assessment frameworks for safe,
effective, patient-centred, timely, efficient and equitable care
(Duckett et al., 2018).
There is great potential to leverage EMR capabilities to achieve
benefits through supporting delivery of high quality nursing care.
The EMR offers a centralised source of electronic clinical infor-
mation and the opportunity to provide accessible, comprehensive,
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18 R.M. Jedwab et al. / Collegian xxx (2018) xxx–xxx
legible, contemporaneous care documentation to support timely,
accurate and consistent patient care and health service delivery
(Burton-Jones & Volkoff, 2017). An EMR can also provide clinical
decision support for nurses to access and use best-evidence, prac-
tice guidelines and workplace policies and procedures to improve
care delivery as well as reduce nurse workload and cognitive bur-
dens that are problematic in current paper systems (Akhu-Zaheya
et al., 2017).
Whilst a large number of indicators were identified in this
review, the evidence for their use, individually or in combination, as
measures of nursing care benefits of EMR implementation is weak.
Measuring the quality and consistency of nursing care is a complex
challenge. EMR systems offer a repository for clinical information
about care of the patient delivered by nursing staff. Current gaps in
evidence relate to how to capture the multifactorial components
of nursing care in data collection. Further, any measure of bene-
fits should consider that efforts to prevent errors using technology
often introduce new ones (Wickramasinghe et al., 2014) and there
is a lack of vigorous research on the cost-effectiveness and safety
risks related to implementing many new technologies in healthcare
settings (Black et al., 2011).
Limitations of this review related to inclusion of only English
language papers, no formal quality analysis, and identification of
many measures that have not been rigorously tested in the con-
text of an EMR implementation. This may limit the utility of some
measures included in the findings. Strengths of this scoping review
relate to the broad scope of literature examined, and identification
of gaps. Potential measures of nursing benefits of EMR implemen-
tation identified in this review are extensive and represent the
multifactorial components of nursing work.
The next step is to use the outcomes of this review to inform a
program to test, monitor and evaluate the nursing benefits associ-
ated with an EMR system implementation. Future examination and
evaluation of potential nursing benefits of EMR should explore how
the EMR can be leveraged to enhance measurement of the quality
of nursing work, and develop indicators of care to improve quality
patient-centred care delivery (Global eHealth Executive Council,
2014).
5. Conclusion
Evaluation of benefits of EMR systems need to be carefully
aligned with the multifactorial components of nursing care in
Australia. Evaluation of EMR implementation should be mindful
of both the intended and unintended consequences for the quality
of nursing work. This review identified a large number of poten-
tial measures as well as number of gaps to guide strategies for
implementation, evaluation, optimisation and ongoing monitoring
of EMR systems for nursing work in Australian hospitals. Fur-
ther research should test the reliability, validity and sensitivity of
measures, and address identified gaps in process measured and
patient-centred care.
Ethical statement
An ethical statement is not applicable for this research.
Conflict of interest
There are no conflicts of interest declared by the authors.
Acknowledgement
The authors would like to thank Professor Alison M. Hutchinson
(RN, PhD) for her support.
Please cite this article in press as: Jedwab, R. M., et al. Measuring nursing benefits of an electronic medical record system: A scoping
review. Collegian (2018), https://doi.org/10.1016/j.colegn.2019.01.003
References
Advisory Board International Global Centre for Nursing Executives. (2015).
Nursing’s role in achieving care continuity: Building a system that never
discharges a patient Retrieved from. https://www.advisory.com/research/
nursing-executive-center/studies/2015/achieving-care-continuity
Akhu-Zaheya, L., Al-Maaitah, R., & Bany Hani, S. (2017). Quality of nursing
documentation: Paper-based health records versus electronic-based health
records. Journal of Clinical Nursing, 27(3–4), e578–e589. http://dx.doi.org/10.
1111/jocn.14097
Ali, S., & Sieloff, C. L. (2017). Nurse’s use of power to standardise nursing
terminology in electronic health records. Journal of Nursing Management, 25(5),
346–353. http://dx.doi.org/10.1111/jonm.12471
Allen, G. B., Miller, V., Nicholas, C., Hess, S., Cordes, M. K., Fortune, J. B., . . . & Ricci,
M. (2014). A multitiered strategy of simulation training, kit consolidation, and
electronic documentation is associated with a reduction in central
line-associated bloodstream infections. American Journal of Infection Control,
42(6), 643–648. http://dx.doi.org/10.1016/j.ajic.2014.02.014
Amato, M. G., Salazar, A., Hickman, T. T., Quist, A. J., Volk, L. A., Wright, A., . . . &
Schiff, G. D. (2017). Computerized prescriber order entry-related patient safety
reports: Analysis of 2522 medication errors. Journal of the American Medical
Informatics Association, 24(2), 316–322. http://dx.doi.org/10.1093/jamia/
ocw125
Amland, R. C., & Hahn-Cover, K. E. (2016). Clinical decision support for early
recognition of sepsis. American Journal of Medical Quality, 31(2), 103–110.
http://dx.doi.org/10.1177/1062860614557636
Arksey, H., & O’Malley, L. (2005). Scoping studies: Towards a methodological
framework. International Journal of Social Research Methodology, 8(1), 19–32.
http://dx.doi.org/10.1080/1364557032000119616
Asaro, P. V., & Boxerman, S. B. (2008). Effects of computerized provider order entry
and nursing documentation on workflow. Academic Emergency Medicine,
15(10), 908–915. http://dx.doi.org/10.1111/j.1553-2712.2008.00235.x
Australian Commission on Safety, & Quality in Health Care. (2010). Australian
safety and quality framework for health care. Sydney, NSW: ACSQHC.
Australian Commission on Safety and Quality in Health Care. (2017a). National
safety and quality health service standards. Sydney, NSW: ACSQHC.
Australian Commission on Safety and Quality in Health Care. (2017b). Vital signs
2017: The state of safety and quality in Australian health care. Sydney, NSW:
ACSQHC.
Australian Council on Health Care Standards. (2010). The ACHS equip 5 guide.
Sydney, NSW: ACHS.
Australian Institute of Health and Welfare. (2018). Australia’s health, 2018.
Canberra, ACT: AIHW.
Bardach, S. H., Real, K., & Bardach, D. R. (2017). Perspectives of healthcare
practitioners: An exploration of interprofessional communication using
electronic medical records. Journal of Interprofessional Care, 31(3), 300–306.
http://dx.doi.org/10.1080/13561820.2016.1269312
Barker, L. A., Gout, B. S., & Crowe, T. C. (2011). Prevalence, identification and impact
on patients and the healthcare system. International Journal of Environmental
Research and Public Health, 8(2), 514–527. http://dx.doi.org/10.3390/
ijerph8020514
Bates, D. W., & Gawande, A. A. (2003). Improving safety with information
technology. The New England Journal of Medicine, 348(25), 2526–2534.
Baysari, M. T., Jackson, N., Ramasamy, S., Santiago, P., Xiong, J., Westbrook, J., . . . &
Day, R. O. (2016). Exploring sub-optimal use of an electronic risk assessment
tool for venous thromboembolism. Applied Ergonomics, 55, 63–69. http://dx.
doi.org/10.1016/j.apergo.2016.01.003
Bingham, G., Fossum, M., Barratt, M., & Bucknall, T. (2015). Clinical review criteria
and medical emergency teams: Evaluating a two-tier rapid response system.
Critical Care and Resuscitation, 17(3), 167–173.
Black, A. D., Car, J., Pagliari, C., Anandan, C., Cresswell, K., Bokun, T., . . . & Sheikh, A.
(2011). The impact of eHealth on the quality and safety of health care: A
systematic overview. PLoS Medicine, 8(1), e1000387 http://dx.doi.org/10.1371/
journal.pmed.1000387
Blackman, I., Henderson, J., Willis, E., Hamilton, P., Toffoli, L., Verrall, C., . . . &
Harvey, C. (2015). Factors influencing why nursing care is missed. Journal of
Clinical Nursing, 24(1-2), 47–56. http://dx.doi.org/10.1111/jocn.12688
Bond, C. A., & Raehl, C. L. (2007). Clinical pharmacy services, pharmacy staffing, and
hospital mortality rates. Pharmacotherapy, 27(4), 481–493. http://dx.doi.org/
10.1592/phco.27.4.481
Bragadottir, H., Kalisch, B. J., & Tryggvadottir, G. B. (2017). Correlates and
predictors of missed nursing care in hospitals. Journal of Clinical Nursing,
26(11-12), 1524–1534. http://dx.doi.org/10.1111/jocn.13449
Brandt, B. N., Gartner, A. B., Moncure, M., Cannon, C. M., Carlton, E., Cleek, C., . . . &
Simpson, S. Q. (2015). Identifying severe sepsis via electronic surveillance.
American Journal of Medical Quality, 30(6), 559–565. http://dx.doi.org/10.1177/
1062860614541291
Brown, C. L., Mulcaster, H. L., Triffitt, K. L., Sittig, D. F., Ash, J. S., Reygate, K., . . . &
Slight, S. P. (2017). A systematic review of the types and causes of prescribing
errors generated from using computerized provider order entry systems in
primary and secondary care. Journal of the American Medical Informatics
Association, 24(2), 432–440. http://dx.doi.org/10.1093/jamia/ocw119
Brown, D. S., Donaldson, N., Bolton, L. B., & Aydin, C. E. (2010). Nursing-sensitive
benchmarks for hospitals to gauge high-reliability performance. Journal for
Healthcare Quality, 32(6), 9–17.
G Model
COLEGN-587; No. of Pages 21 ARTICLE IN PRESS
R.M. Jedwab et al. / Collegian xxx (2018) xxx–xxx
Burkett, E., Martin-Khan, M. G., & Gray, L. C. (2017). Quality indicators in the care of
older persons in the emergency department: A systematic review of the
literature. Australasian Journal on Ageing, 36(4), 286–298. http://dx.doi.org/10.
1111/ajag.12451
Burns, A., Gallagley, A., Byrne, J., & Delirium. (2004). Journal of Neurology,
Neurosurgery & Psychiatry, 75(3), 362–367. http://dx.doi.org/10.1136/jnnp.
2003.023366
Burton-Jones, A., & Volkoff, O. (2017). How can we develop contextualized theories
of effective use? A demonstration in the context of community-care electronic
health records. Information Systems Research, 28(3), 468–489. http://dx.doi.org/
10.1287/isre.2017.0702
Callen, J., Hordern, A., Gibson, K., Li, L., Hains, I. M., & Westbrook, J. I. (2013). Can
technology change the work of nurses? Evaluation of a drug monitoring
system for ambulatory chronic disease patients. International Journal of Medical
Informatics, 82(3), 159–167. http://dx.doi.org/10.1016/j.ijmedinf.2012.11.009
Campanella, P., Lovato, E., Marone, C., Fallacara, L., Mancuso, A., Ricciardi, W., . . . &
Specchia, M. L. (2016). The impact of electronic health records on healthcare
quality: A systematic review and meta-analysis. European Journal of Public
Health, 26(1), 60–64. http://dx.doi.org/10.1093/eurpub/ckv122
Chaboyer, W., Wallis, M., Duffield, C., Courtney, M., Seaton, P., Holzhauser, K., . . . &
Bost, N. (2008). A comparison of activities undertaken by enrolled and
registered nurses on medical wards in Australia: An observational study.
International Journal of Nursing Studies, 45(9), 1274–1284. http://dx.doi.org/10.
1016/j.ijnurstu.2007.10.007
Chand, S., & Sarin, J. (2014). Electronic nursing documentation. International
Journal of Information Dissemination and Technology, 4(4), 328–331.
Chaudhry, B., Wang, J., Wu, S., Maglione, M., Mojica, W., Roth, E., . . . & Shekelle, P. G.
(2006). Systematic review: Impact of health information technology on quality,
efficiency, and costs of medical care. Annals of Internal Medicine, 144, 742–752.
Cho, I., & Noh, M. (2010). Braden scale: Evaluation of clinical usefulness in an
intensive care unit. Journal of Advanced Nursing, 66(2), 293–302. http://dx.doi.
org/10.1111/j.1365-2648.2009.05153.x
Cho, I., Park, I., Kim, E., Lee, E., & Bates, D. W. (2013). Using ehr data to predict
hospital-acquired pressure ulcers: A prospective study of a bayesian network
model. International Journal of Medical Informatics, 82(11), 1059–1067. http://
dx.doi.org/10.1016/j.ijmedinf.2013.06.012
Cox, J. (2011). Predictors of pressure ulcers in adult critical care patients. American
Journal of Critical Care, 20(5), 364–375. http://dx.doi.org/10.4037/ajcc2011934
Despins, L. A. (2017). Automated detection of sepsis using electronic medical
record data: A systematic review. Journal for Healthcare Quality, 39(6),
322–333. http://dx.doi.org/10.1097/JHQ.0000000000000066
Donabedian, A. (1988). The quality of care: How can it be assessed? Journal of the
American Medical Association, 260(12), 1743–1748.
Dowding, D. W., Turley, M., & Garrido, T. (2012). The impact of an electronic health
record on nurse sensitive patient outcomes: An interrupted time series
analysis. Journal of the American Medical Informatics Association, 19(4),
615–620. http://dx.doi.org/10.1136/amiajnl-2011-000504
Duckett, S., Jorm, C., Danks, L., & Moran, G. (2018). All complications should count:
Using our data to make hospitals safer. Grattan Institute.
Duffield, C., Gardner, G., & Catling-Paull, C. (2008). Nursing work and the use of
nursing time. Journal of Clinical Nursing, 17(24), 3269–3274. http://dx.doi.org/
10.1111/j.1365-2702.2008.02637.x
Dunton, N., Gajewski, B., Klaus, S., & Pierson, B. (2007). The relationship of nursing
workforce characteristics to patient outcomes. Online Journal of Issues in
Nursing, 12(3).
Dunton, N., Gajewski, B., Taunton, R. L., & Moore, J. (2004). Nurse staffing and
patient falls on acute care hospital units. Nursing Outlook, 52(1), 53–59. http://
dx.doi.org/10.1016/j.outlook.2003.11.006
Dykes, P. C., & Collins, S. A. (2013). Building linkages between nursing care and
improved patient outcomes: The role of health information technology. Online
Journal of Issues in Nursing, 18(3), 4. http://dx.doi.org/10.3912/OJIN.
Vol18No03Man04
Eden, R., Burton-Jones, A., Scott, I., Staib, A., & Sullivan, C. (2017). The impacts of
eHealth upon hospital practice: Synthesis of the current litrerature. Canberra,
ACT: Deeble Institute.
Forni, A., Chu, H. T., & Fanikos, J. (2010). Technology utilization to prevent
medication errors. Current Drug Safety, 5(1), 13–18.
Furukawa, M. F., Raghu, T. S., & Shao, B. B. (2010). Electronic medical records, nurse
staffing, and nurse-sensitive patient outcomes: Evidence from California
hospitals, 1998–2007. Health Services Research, 45(4), 941–962. http://dx.doi.
org/10.1111/j.1475-6773.2010.01110.x
Garcia-Fernandez, F. P., Pancorbo-Hidalgo, P. L., & Agreda, J. J. (2014). Predictive
capacity of risk assessment scales and clinical judgment for pressure ulcers: A
meta-analysis. Journal of Wound Ostomy & Continence Nursing, 41(1), 24–34.
http://dx.doi.org/10.1097/01.WON.0000438014.90734.a2
Global eHealth Executive Council. (2014). Reducing hospital lengths of stay with
EMRs and other information technologies. London, United Kingdom: The
Advisory Board Company.
Griffiths, P., Recio-Saucedo, A., Dall’Ora, C., Briggs, J., Maruotti, A., Meredith, P., . . .
& Smith, G. B. (2017). The association between nurse staffing and omissions in
nursing care: A systematic review. Journal of Advanced Nursing, http://dx.doi.
org/10.1111/jan.13564
Gunningberg, L., Dahm, M. F., & Ehrenberg, A. (2008). Accuracy in the recording of
pressure ulcers and prevention after implementing an electronic health record
in hospital care. Quality & Safety in Health Care, 17(4), 281–285. http://dx.doi.
org/10.1136/qshc.2007.023341
Please cite this article in press as: Jedwab, R. M., et al. Measuring nursing benefits of an electronic medical record system: A scoping
review. Collegian (2018), https://doi.org/10.1016/j.colegn.2019.01.003
19
Gunningberg, L., & Ehrenberg, A. (2004). Accuracy and quality in the nursing
documentation of pressure ulcers: A comparison of record content and patient
examination. Journal of Wound Ostomy & Continence Nursing, 31(6), 328–335.
Gunningberg, L., Fogelberg-Dahm, M., & Ehrenberg, A. (2009). Improved quality
and comprehensiveness in nursing documentation of pressure ulcers after
implementing an electronic health record in hospital care. Journal of Clinical
Nursing, 18(11), 1557–1564. http://dx.doi.org/10.1111/j.1365-2702.2008.
02647.x
Haines, T. P., Hill, A.-M., Hill, K. D., Brauer, S. G., Hoffmann, T., Etherton-Beer, C., &
McPhail, S. M. (2013). Cost effectiveness of patient education for the prevention
of falls in hospital: Economic evaluation from a randomized controlled trial.
BMC Medicine, 11(135), 1–12. http://dx.doi.org/10.1186/1741-7015-11-135
Hakes, B., & Whittington, J. (2008). Assessing the impact of an electronic medical
record on nurse documentation time. CIN Computers, Informatics, Nursing,
26(4), 234–241. http://dx.doi.org/10.1097/01.NCN.0000304801.00628.ab
Harmon, C. S., Fogle, M., & Roussel, L. (2015). Then and now: Nurses’ perceptions of
the electronic health record. Online Journal of Nursing Informatics, 19(1).
Harrison, R., Walton, M., Manias, E., Smith-Merry, J., Kelly, P., Iedema, R., &
Robinson, L. (2015). The missing evidence: A systematic review of patients’
experiences of adverse events in health care. International Journal for Quality in
Health Care, 27(6), 424–442. http://dx.doi.org/10.1093/intqhc/mzv075
Hauck, K., & Zhao, X. (2011). How dangerous is a day in hospital? A model of
adverse events and length of stay for medical inpatients. Medical Care, 49(12),
1068–1075. http://dx.doi.org/10.1097/MLR.0b013e31822efb09
Haynes, K., Linkin, D. R., Fishman, N. O., Bilker, W. B., Strom, B. L., Pifer, E. A., &
Hennessy, S. (2011). Effectiveness of an information technology intervention
to improve prophylactic antibacterial use in the postoperative period. Journal
of the American Medical Informatics Association, 18(2), 164–168. http://dx.doi.
org/10.1136/jamia.2009.002998
Herasevich, V., Pieper, M. S., Pulido, J., & Gajic, O. (2011). Enrollment into a time
sensitive clinical study in the critical care setting: Results from computerized
septic shock sniffer implementation. Journal of the American Medical Informatics
Association, 18(5), 639–644. http://dx.doi.org/10.1136/amiajnl-2011-000228
Hollenbeak, C. S. (2011). The cost of catheter-related bloodstream infections:
Implications for the value of prevention. Journal of Infusion Nursing, 34(5),
309–313. http://dx.doi.org/10.1097/NAN.0b013e3182285e43
Hooper, K., & Jacobs, P. (2009). Halting the sepsis cascade. The Cerner Quarterly,
5(1), 15–23.
Hoover, R. (2016). Benefits of using an electronic health record. Nursing, 46(7),
21–22. http://dx.doi.org/10.1097/01.NURSE.0000484036.85939.06
Hope, C., Estrada, N., Weir, C., Teng, C.-C., Damal, K., & Sauer, B. C. (2014).
Documentation of delirium in the VA electronic health record. BMC Research
Notes, 3(7), 208–217. http://dx.doi.org/10.1186/1756-0500-7-208
Hripcsak, G., Vawdrey, D. K., Fred, M. R., & Bostwick, S. B. (2011). Use of electronic
clinical documentation: Time spent and team interactions. Journal of the
American Medical Informatics Association, 18(2), 112–117. http://dx.doi.org/10.
1136/jamia.2010.008441
Inacio, M. C., Paxton, E. W., Chen, Y., Harris, J., Eck, E., Barnes, S., . . . & Ake, C. F.
(2011). Leveraging electronic medical records for surveillance of surgical site
infection in a total joint replacement population. Infection Control & Hospital
Epidemiology, 32(4), 351–359. http://dx.doi.org/10.1086/658942
Jayawardena, S., Eisdorfer, J., Indulkar, S., Ajith Pal, S., Sooriabalan, D., & Cucco, R.
(2007). Prescription errors and the impact of computerized prescription order
entry system in a community-based hospital. American Journal of Therapeutics,
14(4), 336–340. http://dx.doi.org/10.1097/01.mjt.0000209681.22077.b9
Jheeta, S., & Franklin, B. D. (2017). The impact of a hospital electronic prescribing
and medication administration system on medication administration safety:
An observational study. BMC Health Services Research, 17(1), 547. http://dx.doi.
org/10.1186/s12913-017-2462-2
Jin, Y., Piao, J., & Lee, S. M. (2015). Evaluating the validity of the Braden scale using
longitudinal electronic medical records. Research in Nursing & Health, 38(2),
152–161. http://dx.doi.org/10.1002/nur.21642
Johnson, M., Jefferies, D., & Nicholls, D. (2012). Developing a minimum data set for
electronic nursing handover. Journal of Clinical Nursing, 21(3-4), 331–343.
http://dx.doi.org/10.1111/j.1365-2702.2011.03891.x
Jones, T. L., Hamilton, P., & Murry, N. (2015). Unfinished nursing care, missed care,
and implicitly rationed care: State of the science review. International Journal
of Nursing Studies, 52(6), 1121–1137. http://dx.doi.org/10.1016/j.ijnurstu.2015.
02.012
Kaewprag, P., Newton, C., Vermillion, B., Hyun, S., Huang, K., & Machiraju, R. (2017).
Predictive models for pressure ulcers from intensive care unit electronic health
records using bayesian networks. BMC Medical Informatics and Decision Making,
17(Supplement 2), 65. http://dx.doi.org/10.1186/s12911-017-0471-z
Kahn, S. R., Lim, W., Dunn, A. S., Cushman, M., Dentali, F., Akl, E. A., . . . & Murad, M.
H. (2012). Prevention of VTE in nonsurgical patients: Antithrombotic therapy
and prevention of thrombosis, 9th ed: American college of chest physicians
evidence-based clinical practice guidelines. Chest, 141(Supplement 2),
e195S–e226S. http://dx.doi.org/10.1378/chest.11-2296
Kalisch, B. J., Tschannen, D., & Lee, K. H. (2012). Missed nursing care, staffing, and
patient falls. Journal of Nursing Care Quality, 27(1), 6–12. http://dx.doi.org/10.
1097/NCQ.0b013e318225aa23
Keenan, G., Yakel, E., Dunn Lopez, K., Tschannen, D., & Ford, Y. B. (2013). Challenges
to nurses’ efforts of retrieving, documenting, and communicating patient care
information. Journal of the American Medical Informatics Association, 20(2),
245–251. http://dx.doi.org/10.1136/amiajnl-2012-000894
G Model
COLEGN-587; No. of Pages 21 ARTICLE IN PRESS
20 R.M. Jedwab et al. / Collegian xxx (2018) xxx–xxx
Khan, A., Simpson, M., Singh, M., Hook, M., Geng, Y., & Malone, M. L. (2015).
Innovative approach to measure delirium in hospitalized older adults using the
electronic health record. Journal of the American Geriatrics Society, 63(3),
593–594.
Khurana, H. S., Groves, RH, Jr., Simons, M. P., Martin, M., Stoffer, B., Kou, S., . . . &
Parthasarathy, S. (2016). Real-time automated sampling of electronic medical
records predicts hospital mortality. The American Journal of Medicine, 129(7),
688–698. http://dx.doi.org/10.1016/j.amjmed.2016.02.037
Kim, M. O., Coiera, E., & Magrabi, F. (2017). Problems with health information
technology and their effects on care delivery and patient outcomes: A
systematic review. Journal of the American Medical Informatics Association,
24(2), 246–250. http://dx.doi.org/10.1093/jamia/ocw154
Kitson, A., Conroy, T., Kuluski, K., Locock, L., & Lyons, R. (2013). Reclaiming and
redefining the fundamentals of care: Nursing’s response to meeting patients’ basic
human needs. Adelaide, South Australia: School of Nursing, The University of
Adelaide.
Kossman, S. P., & Scheidenhelm, S. L. (2008). Nurses’ perceptions of the impact of
electronic health records on work and patient outcomes. CIN Computers
Informatics Nursing, 26(2), 69–77.
Kurczewski, L., Sweet, M., McKnight, R., & Halbritter, K. (2015). Reduction in time
to first action as a result of electronic alerts for early sepsis recognition. Critical
Care Nursing Quarterly, 38(2), 182–187. http://dx.doi.org/10.1097/CNQ.
0000000000000060
Lake, E. T., Shang, J., Klaus, S., & Dunton, N. E. (2010). Patient falls: Association with
hospital magnet status and nursing unit staffing. Research in Nursing & Health,
33(5), 413–425. http://dx.doi.org/10.1002/nur.20399
Leonard, M., Graham, S., & Bonacum, D. (2004). The human factor: The critical
importance of effective teamwork and communication in providing safe care.
Quality & Safety in Health Care, 13(S1), i85–i90. http://dx.doi.org/10.1136/qshc.
2004.010033
Levac, D., Colquhoun, H., & O’Brien, K. K. (2010). Scoping studies: Advancing the
methodology. Implementation Science, 5, 69. http://dx.doi.org/10.1186/1748-
5908-5-69
Li, D., & Korniewicz, D. M. (2013). Determination of the effectiveness of electronic
health records to document pressure ulcers. Medsurg Nursing, 22(1), 17–25.
Lim, S. L., Ong, K. C., Chan, Y. H., Loke, W. C., Ferguson, M., & Daniels, L. (2012).
Malnutrition and its impact on cost of hospitalization, length of stay,
readmission and 3-year mortality. Clinical Nutrition, 31(3), 345–350. http://dx.
doi.org/10.1016/j.clnu.2011.11.001
Liu, J., Luo, L., Zhang, R., & Huang, T. (2013). Patient satisfaction with electronic
medical/health record: A systematic review. Scandinavian Journal of Caring
Sciences, 27(4), 785–791. http://dx.doi.org/10.1111/scs.12015
Liu, X., Zheng, J., Liu, K., Baggs, J. G., Liu, J., Wu, Y., . . . & You, L. (2018). Hospital
nursing organizational factors, nursing care left undone, and nurse burnout as
predictors of patient safety: A structural equation modeling analysis.
International Journal of Nursing Studies, 86, 82–89. http://dx.doi.org/10.1016/j.
ijnurstu.2018.05.005
Lo, Y. S., Lee, W. S., & Liu, C. T. (2013). Utilization of electronic medical records to
build a detection model for surveillance of healthcare-associated urinary tract
infections. Journal of Medical Systems, 37(2), 9923. http://dx.doi.org/10.1007/
s10916-012-9923-2
Manaktala, S., & Claypool, S. R. (2017). Evaluating the impact of a computerized
surveillance algorithm and decision support system on sepsis mortality.
Journal of the American Medical Informatics Association, 24(1), 88–95. http://dx.
doi.org/10.1093/jamia/ocw056
Marier, A., Olsho, L. E., Rhodes, W., & Spector, W. D. (2016). Improving prediction of
fall risk among nursing home residents using electronic medical records.
Journal of the American Medical Informatics Association, 23(2), 276–282. http://
dx.doi.org/10.1093/jamia/ocv061
Mattison, M., Afonso, K. A., Ngo, L. H., & Mukamal, K. J. (2010). Preventing
potentially inappropriate medication use in hospitalized older patients with a
Computerized Provider Order Entry Warning System. Archives of Internal
Medicine, 170(5), 1331–1336.
McRee, L., Thanavaro, J. L., Moore, K., Goldsmith, M., & Pasvogel, A. (2014). The
impact of an electronic medical record surveillance program on outcomes for
patients with sepsis. Heart & Lung, 43(6), 546–549. http://dx.doi.org/10.1016/j.
hrtlng.2014.05.009
Miller, D. M., Neelon, L., Kish-Smith, K., Whitney, L., & Burant, C. J. (2017). Pressure
injury knowledge in critical care nurses. Journal of Wound Ostomy & Continence
Nursing, 44(5), 455–457. http://dx.doi.org/10.1097/WON.0000000000000350
Miller, N., Frankenfield, D., Lehman, E., Maguire, M., & Schirm, V. (2016). Predicting
pressure ulcer development in clinical practice: Evaluation of braden scale
scores and nutrition parameters. Journal of Wound Ostomy & Continence
Nursing, 43(2), 133–139. http://dx.doi.org/10.1097/WON.0000000000000184
Moon, K. J., Jin, Y., Jin, T., & Lee, S. M. (2018). Development and validation of an
automated delirium risk assessment system (Auto-DelRAS) implemented in
the electronic health record system. International Journal of Nursing Studies, 77,
46–53. http://dx.doi.org/10.1016/j.ijnurstu.2017.09.014
Nabhan, M., Elraiyah, T., Brown, D. R., Dilling, J., LeBlanc, A., Montori, V. M., . . . &
Murad, M. H. (2012). What is preventable harm in healthcare? A systematic
review of definitions. BMC Health Services Research, 25(12), 128. http://dx.doi.
org/10.1186/1472-6963-12-128
Narayanan, N., Gross, A. K., Pintens, M., Fee, C., & MacDougall, C. (2016). Effect of an
electronic medical record alert for severe sepsis among ED patients. The
American Journal of Emergency Medicine, 34(2), 185–188. http://dx.doi.org/10.
1016/j.ajem.2015.10.005
Please cite this article in press as: Jedwab, R. M., et al. Measuring nursing benefits of an electronic medical record system: A scoping
review. Collegian (2018), https://doi.org/10.1016/j.colegn.2019.01.003
Nebeker, J. R. (2002). Developing a taxonomy for research in adverse drug events:
Potholes and signposts. Journal of the American Medical Informatics Association,
9(6), S80–S85. http://dx.doi.org/10.1197/jamia.M1234
Nguyen, L., & Wickramasinghe, N. (2017). An examination of the mediating role for
a nursing information system. Australasian Journal of Information Systems, 21,
1–21.
Nguyen, S. Q., Mwakalindile, E., Booth, J. S., Hogan, V., Morgan, J., Prickett, C. T., . . .
& Wang, H. E. (2014). Automated electronic medical record sepsis detection in
the emergency department. PeerJ, 2, e343. http://dx.doi.org/10.7717/peerj.343
Nursing and Midwifery Board of Australia. (2016). Registered nurse standards for
practice. Melbourne, VIC: Nursing and Midwifery Board of Australia.
Nursing and Midwifery Board of Australia. (2018a). Professional codes & guidelines:
Professional standards Retrieved from. http://www.nursingmidwiferyboard.
gov.au/Codes-Guidelines-Statements/Professional-standards.aspx
Nursing and Midwifery Board of Australia. (2018b). Professional codes & guidelines:
Guidelines Retrieved from. http://www.nursingmidwiferyboard.gov.au/Codes-
Guidelines-Statements/Codes-Guidelines.aspx
Nursing and Midwifery Board of Australia. (2018c). Professional codes & guidelines:
Policies Retrieved from. http://www.nursingmidwiferyboard.gov.au/Codes-
Guidelines-Statements/Policies.aspx
O’Tuathail, C., & Taqi, R. (2011). Evaluation of three commonly used pressure ulcer
risk assessment scales. British Journal of Nursing, 20(6), S27–S34. http://dx.doi.
org/10.12968/bjon.2011.20.Sup2.S27
Olenick, E. M., Zimbro, K. S., D’Lima, G. M., Ver Schneider, P., & Jones, D. (2017).
Predicting sepsis risk using the “sniffer” algorithm in the electronic medical
record. Journal of Nursing Care Quality, 32(1), 25–31. http://dx.doi.org/10.1097/
NCQ.0000000000000198
Oh, S. H., Park, E. J., Jin, Y., Piao, J., & Lee, S. M. (2014). Automatic delirium
prediction system in a Korean surgical intensive care unit. Nursing in Critical
Care, 19(6), 281–291. http://dx.doi.org/10.1111/nicc.12048
Ortega, A., Aguinagalde, A., Lacasa, C., Aquerreta, I., Fernandez-Benitez, M., &
Fernandez, L. M. (2008). Efficacy of an adverse drug reaction electronic
reporting system integrated into a hospital information system. The Annals of
Pharmacotherapy, 42(10), 1491–1496. http://dx.doi.org/10.1345/aph.1L130
Osheroff, J. A., Teich, J. M., Middleton, B., Steen, E. B., Wright, A., & Detmer, D. E.
(2007). A Roadmap for national action on clinical decision support. Journal of
the American Medical Informatics Association, 14(2), 141–145.
Pageler, N. M., Longhurst, C. A., Wood, M., Cornfield, D. N., Suermondt, J., Sharek, P.
J., . . . & Franzon, D. (2014). Use of electronic medical record-enhanced
checklist and electronic dashboard to decrease CLABSIs. Pediatrics, 133(3),
e738–746. http://dx.doi.org/10.1542/peds.2013-2249
Park, S. H., Blegen, M. A., Spetz, J., Chapman, S. A., & De Groot, H. A. (2015).
Comparison of nurse staffing measurements in staffing-outcomes research.
Medical Care, 53(1), e1–e8.
Paul, L., & Robinson, K. M. (2012). Capture and documentation of coded data on
adverse drug reactions: An overview. Health Information Management Journal,
41(3), 27–36.
Piscotty, R. J., Kalisch, B., Gracey-Thomas, A., & Yarandi, H. (2015). Electronic
nursing care reminders: Implications for nursing leaders. JONA The Journal of
Nursing Administration, 45(5), 239–242. http://dx.doi.org/10.1097/NNA.
0000000000000192
Plaskitt, A., Heywood, N., & Arrowsmith, M. (2015). Recording pressure ulcer risk
assessment and incidence. Nursing Standard, 29(46), 54–61.
Ray, S., Laur, C., & Golubic, R. (2014). Malnutrition in healthcare institutions: A
review of the prevalence of under-nutrition in hospitals and care homes since
1994 in England. Clinical Nutrition, 33(5), 829–835. http://dx.doi.org/10.1016/j.
clnu.2013.10.017
Redley, B., & Baker, T. (2018). Have you SCAND MMe please? A framework to
prevent harm during acute hospitalisation of older persons: A retrospective
audit. Journal of Clinical Nursing, 28(3-4), 560–574. http://dx.doi.org/10.1111/
jocn.14650
Redley, B., & Raggatt, M. (2017). Use of standard risk screening and assessment
forms to prevent harm to older people in Australian hospitals: A mixed
methods study. BMJ Quality & Safety, 26(9), 704–713. http://dx.doi.org/10.
1136/bmjqs-2016-005867
Roberts, L. L., Ward, M. M., Brokel, J. M., Wakefield, D. S., Crandall, D. K., & Conlon, P.
(2010). Impact of health information technology on detection of potential
adverse drug events at the ordering stage. American Journal of Health-System
Pharmacy, 67(21), 1838–1846. http://dx.doi.org/10.2146/ajhp090637
Rogers, M. L., Sockolow, P. S., Bowles, K. H., Hand, K. E., & George, J. (2013). Use of a
human factors approach to uncover informatics needs of nurses in
documentation of care. International Journal of Medical Informatics, 82(11),
1068–1074.
Rossi, M., Campbell, K. L., & Ferguson, M. (2014). Implementation of the nutrition
care process and international dietetics and nutrition terminology in a
single-center hemodialysis unit: Comparing paper vs electronic records.
Journal of the Academy of Nutrition and Dietetics, 114(1), 124–130. http://dx.doi.
org/10.1016/j.jand.2013.07.033
Rothman, M., Levy, M., Dellinger, R. P., Jones, S. L., Fogerty, R. L., Voelker, K. G., &
Beals, J. T. (2017). Sepsis as 2 problems: Identifying sepsis at admission and
predicting onset in the hospital using an electronic medical record-based
acuity score. Journal of Critical Care, 38, 237–244. http://dx.doi.org/10.1016/j.
jcrc.2016.11.037
Rudolph, J. L., Doherty, K., Kelly, B., Driver, J. A., & Archambault, E. (2016).
Validation of a delirium risk assessment using electronic medical record
G Model
COLEGN-587; No. of Pages 21 ARTICLE IN PRESS
R.M. Jedwab et al. / Collegian xxx (2018) xxx–xxx
information. Journal of the American Medical Directors Association, 17(3),
244–248. http://dx.doi.org/10.1016/j.jamda.2015.10.020
Runciman, W., Hibbert, P., Thomson, R., Van Der Schaaf, T., Sherman, H., & Lewalle,
P. (2009). Towards an international classification for patient safety: Key
concepts and terms. International Journal for Quality in Health Care, 21(1),
18–26.
Rycroft-Malone, J., & Bucknall, T. (Eds.). (2010). Models and frameworks for
implementing evidence-based practice: Linking evidence to action. Chichester,
England: John Wiley & Sons.
Saranto, K., Kinnunen, U. M., Kivekas, E., Lappalainen, A. M., Liljamo, P., Rajalahti, E.,
. . . & Hypponen, H. (2014). Impacts of structuring nursing records: A
systematic review. Scandinavian Journal of Caring Sciences, 28(4), 629–647.
http://dx.doi.org/10.1111/scs.12094
Saum, L., & Reeves, D. (2016). Venous thromboembolism prophylaxis compliance
before and after electronic health record implementation. Hospital Pharmacy,
51(2), 142–148. http://dx.doi.org/10.1310/hpj5102-142
Seidling, H. M., Al Barmawi, A., Kaltschmidt, J., Bertsche, T., Pruszydlo, M. G., &
Haefeli, W. E. (2007). Detection and prevention of prescriptions with excessive
doses in electronic prescribing systems. European Journal of Clinical
Pharmacology, 63(12), 1185–1192. http://dx.doi.org/10.1007/s00228-007-
0370-9
Seidling, H. M., Schmitt, S. P., Bruckner, T., Kaltschmidt, J., Pruszydlo, M. G., Senger,
C., . . . & Haefeli, W. E. (2010). Patient-specific electronic decision support
reduces prescription of excessive doses. Quality & Safety in Health Care, 19(5),
e15. http://dx.doi.org/10.1136/qshc.2009.033175
Siddiqi, N., & House, A. (2006). Delirium: An update on diagnosis, treatment and
prevention. Clinical Medicine, 6(6), 540–543.
Smith, D. H., Perrin, N., Feldstein, A., Yang, X., Kuang, D., Simon, S. R., . . . &
Soumerai, S. B. (2006). The impact of prescribing safety alerts for elderly
persons in an electronic medical record: An interrupted time series evaluation.
Archives of Internal Medicine, 166(10), 1098–1104.
Snowden, A., & Kolb, H. (2017). Two years of unintended consequences:
Introducing an electronic health record system in a hospice in Scotland. Journal
of Clinical Nursing, 26(9–10), 1414–1427. http://dx.doi.org/10.1111/jocn.13576
Stalpers, D., de Brouwer, B. J., Kaljouw, M. J., & Schuurmans, M. J. (2015).
Associations between characteristics of the nurse work environment and five
nurse-sensitive patient outcomes in hospitals: A systematic review of
literature. International Journal of Nursing Studies, 52(4), 817–835. http://dx.doi.
org/10.1016/j.ijnurstu.2015.01.005
Stevenson, J. E., & Nilsson, G. (2012). Nurses’ perceptions of an electronic patient
record from a patient safety perspective: A qualitative study. Journal of
Advanced Nursing, 68(3), 667–676. http://dx.doi.org/10.1111/j.1365-2648.
2011.05786.x
Stevenson, J. E., Nilsson, G. C., Petersson, G. I., & Johansson, P. E. (2010). Nurses’
experience of using electronic patient records in everyday practice in
acute/inpatient ward settings: A literature review. Health Informatics Journal,
16(1), 63–72. http://dx.doi.org/10.1177/1460458209345901
Stockton, K. R., Wickham, M. E., Lai, S., Badke, K., Dahri, K., Villanyi, D., . . . & Hohl, C.
M. (2017). Incidence of clinically relevant medication errors in the era of
electronically prepopulated medication reconciliation forms: A retrospective
chart review. CMAJ Open, 5(2), E345–E353. http://dx.doi.org/10.9778/cmajo.
20170023
Sutcliffe, K. M., Lewton, E., & Rosenthal, M. M. (2004). Communication failures: An
insidious contributor to medical mishaps. Academic Medicine, 79(2), 186–194.
Swan, B. A., Becker, J., Rickie Brawer, R., & Sciamanna, C. N. (2011). Factors
influencing the implementation of a point-of-care screening tool for delirium.
Medsurg Nursing, 20(6), 318–322.
Takian, A., Sheikh, A., & Barber, N. (2012). We are bitter, but we are better off: Case
study of the implementation of an electronic health record system into a
mental health hospital in England. BMC Health Services Research, 12, 484.
http://dx.doi.org/10.1186/1472-6963-12-484
Taylor, S. P., Ledford, R., Palmer, V., & Abel, E. (2014). We need to talk: An
observational study of the impact of electronic medical record implementation
on hospital communication. BMJ Quality & Safety, 23(7), 584–588. http://dx.
doi.org/10.1136/bmjqs-2013-002436
Please cite this article in press as: Jedwab, R. M., et al. Measuring nursing benefits of an electronic medical record system: A scoping
review. Collegian (2018), https://doi.org/10.1016/j.colegn.2019.01.003
21
Tescher, A. N., Branda, M. E., Byrne, T. J., & Naessens, J. M. (2012). All at-risk
patients are not created equal: Analysis of braden pressure ulcer risk scores to
identify specific risks. Journal of Wound Ostomy & Continence Nursing, 39(3),
282–291. http://dx.doi.org/10.1097/WON.0b013e3182435715
Thompson, G., O’Horo, J. C., Pickering, B. W., & Herasevich, V. (2015). Impact of the
electronic medical record on mortality, length of stay, and cost in the hospital
and ICU: A systematic review and metaanalysis. Critical Care Medicine, 43(6),
1276–1282. http://dx.doi.org/10.1097/CCM.0000000000000948
Tornvall, E., Wilhelmsson, S., & Wahren, L. K. (2004). Electronic nursing
documentation in primary health care. Scandinavian Journal of Caring Sciences,
18, 310–317. http://dx.doi.org/10.1111/j.1471-6712.2004.00282.x
Tsai, H.-S., & Kong, E. (2013). Using electronic and mobile data services in the
Australian healthcare sector: The challenges from end-users’ viewpoints. The
International Journal of Technology, Knowledge, and Society, 9, 63–71.
Tubaishat, A., Tawalbeh, L. I., Azzam, M. A., AlBashtawy, M., & Batiha, A.-M. (2015).
Electronic versus paper records: Documentation of pressure ulcer data. British
Journal of Nursing, 24(6), S30–S37. http://dx.doi.org/10.12968/bjon.2015.24.
Sup6.S30
VanFosson, C. A., Jones, T. L., & Yoder, L. H. (2016). Unfinished nursing care: An
important performance measure for nursing care systems. Nursing Outlook,
64(2), 124–136. http://dx.doi.org/10.1016/j.outlook.2015.12.010
Verrall, C., Abery, E., Harvey, C., Henderson, J., Willis, E., Hamilton, P., . . . &
Blackman, I. (2015). Nurses and midwives perceptions of missed nursing care –
a South Australian study. Collegian, 22(4), 413–420. http://dx.doi.org/10.1016/j.
colegn.2014.09.001
Wang, N., Yu, P., & Hailey, D. (2013). Description and comparison of documentation
of nursing assessment between paper-based and electronic systems in
Australian aged care homes. International Journal of Medical Informatics, 82(9),
789–797. http://dx.doi.org/10.1016/j.ijmedinf.2013.05.002
Ward, M. J., Froehle, C. M., Hart, K. W., Collins, S. P., & Lindsell, C. J. (2014). Transient
and sustained changes in operational performance, patient evaluation, and
medication administration during electronic health record implementation in
the emergency department. Annals of Emergency Medicine, 63(3), 320–328.
http://dx.doi.org/10.1016/j.annemergmed.2013.08.019
Weiss, M. E., Yakusheva, O., & Bobay, K. L. (2011). Quality and cost analysis of nurse
staffing, discharge preparation, and postdischarge utilization. Health Services
Research, 46(5), 1473–1494. http://dx.doi.org/10.1111/j.1475-6773.2011.
01267.x
Whitman, G. R., Kim, Y., Davidson, L. J., Wolf, G. A., & Wang, S.-L. (2002). The impact
of staffing on patient outcomes across specialty units. Journal of Nursing
Administration, 32(12), 633–639.
Wickramasinghe, N., Kent, B., Moghimi, F. H., Stien, M., Nguyen, L., Redley, B., &
Botti, M. (2014). Using technology solutions to streamline healthcare processes
for nursing: The case of an intelligent operational planning and support tool
(IOPST) solution. In N. Wickramasinghe, L. Hakim, C. Gonzalez, & J. Tan (Eds.),
Lean thinking for healthcare: healthcare delivery in the information age (pp.
405–430). New York, NY: Springer.
Witlox, J., Eurelings, L. S. M., De Jonghe, J. F. M., Kalisvaart, K. J., Eikelenboom, P., &
Van Gool, W. A. (2010). Delirium in elderly patients and the risk of
postdischarge mortality, institutionalization, and dementia: A meta-analysis.
Journal of the American Medical Association, 304(4), 443–451. http://dx.doi.org/
10.1001/jama.2010.1013
Wright, A., Sittig, D. F., Ash, J. S., Bates, D. W., Feblowitz, J., Fraser, G., . . . &
Middleton, B. (2011). Governance for clinical decision support: Case studies
and recommended practices from leading institutions. Journal of the American
Medical Informatics Association, 18(2), 187–194. http://dx.doi.org/10.1136/
jamia.2009.002030
Wright, A., Sittig, D. F., Ash, J. S., Sharma, S., Pang, J. E., & Middleton, B. (2009).
Clinical decision support capabilities of commercially-available clinical
information systems. Journal of the American Medical Informatics Association,
16(5), 637–644. http://dx.doi.org/10.1197/jamia.M3111
Zhang, M., Holman, C. D., Preen, D. B., & Brameld, K. (2007). Repeat adverse drug
reactions causing hospitalization in older australians: A population-based
longitudinal study 1980-2003. British Journal of Clinical Pharmacology, 63(2),
163–170. http://dx.doi.org/10.1111/j.1365-2125.2006.02839.x
Zhang, X. Y., & Zhang, P. (2016). Recent perspectives of electronic medical record
systems. Experimental and Therapeutic Medicine, 11(6), 2083–2085. http://dx.
doi.org/10.3892/etm.2016.3233