A Novel Survey to Examine the Relationship between Health IT Adoption and Nurse-Physician CommunicationFunding This project was supported by grant number R01HS022305 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.
23 August 2016
accepted: 04 November 2016
18 December 2017 (online)
Background As EHR adoption in US hospitals becomes ubiquitous, a wide range of IT options are theoretically available to facilitate physician-nurse communication, but we know little about the adoption rate of specific technologies or the impact of their use.
Objectives To measure adoption of hardware, software, and telephony relevant to nurse-physician communication in US hospitals. To assess the relationship between non-IT communication practices and hardware, software, and telephony adoption. To identify hospital characteristics associated with greater adoption of hardware, software, telephony, and non-IT communication practices.
Methods We conducted a survey of 105 hospitals in the National Nursing Practice Network. The survey captured adoption of hardware, software, and telephony to support nurse-physician communication, along with non-IT communication practices. We calculated descriptive statistics and then created four indices, one for each category, by scoring degree of adoption of technologies or practices within each category. Next, we examined correlations between the three technology indices and the non-IT communication practices index. We used multivariate OLS regression to assess whether certain types of hospitals had higher index scores.
Results The majority of hospitals surveyed have a range of hardware, software, and telephony tools available to support nurse-physician communication; we found substantial heterogeneity across hospitals in non-IT communication practices. More intensive non-IT communication was associated with greater adoption of software (r=0.31, p=0.01), but was not correlated with hardware or telephony. Medium-sized hospitals had lower adoption of software (r =−1.14,p=0.04) in comparison to small hospitals, while federally-owned hospitals had lower software (r=−2.57, p=0.02) and hardware adoption (r=−1.63, p=0.01).
Conclusions The positive relationship between non-IT communication and level of software adoption suggests that there is a complementary, rather than substitutive, relationship. Our results suggest that some technologies with the potential to further enhance communication, such as CPOE and secure messaging, are not being utilized to their full potential in many hospitals.
Citation: Holmgren AJ, Pfeifer E, Manojlovich M, Adler-Milstein J. A novel survey to examine the relationship between health IT adoption and nurse-physician communication.
- 1 Blumenthal D. Launching HITECH. N Engl J Med 2010; 362 (05) 382-385 doi: 10.1056/NEJMp0912825..
- 2 Bloomrosen M, Starren J, Lorenzi NM, Ash JS, Patel VL, Shortliffe EH. Anticipating and addressing the unintended consequences of health IT and policy: a report from the AMIA 2009 Health Policy Meeting. Journal of the American Medical Informatics Association 2011; 18 (01) 82-90 doi: 10.1136/jamia.2010.007567..
- 3 Ash JS, Berg M, Coiera E. Some unintended consequences of information technology in health care: the nature of patient care information system-related errors. Journal of the American Medical Informatics Association 2004; 11 (02) 104-112.
- 4 Pirnejad H, Niazkhani Z, van der Sijs H, Berg M, Bal R. Impact of a computerized physician order entry system on nurse–physician collaboration in the medication process. International journal of medical informatics 2008; 77 (11) 735-744.
- 5 Quan SD, Wu RC, Rossos PG, Arany T, Groe S, Morra D, Wong BM, Cavalcanti R, Coke W, Lau FY. It’s not about pager replacement: An in-depth look at the interprofessional nature of communication in health-care. Journal of hospital medicine 2013; 08 (03) 137-143.
- 6 Chiasson M, Reddy M, Kaplan B, Davidson E. Expanding multi-disciplinary approaches to healthcare information technologies: what does information systems offer medical informatics?. International journal of medical informatics 2007; 76: S89-S97.
- 7 Sutcliffe KM, Lewton E, Rosenthal MM. Communication failures: an insidious contributor to medical mishaps. ACADEMIC MEDICINE-PHILADELPHIA 2004; 79 (02) 186-194.
- 8 Manojlovich M, Adler-Milstein J, Harrod M, Sales A, Hofer TP, Saint S, Krein SL. The Effect of Health Information Technology on Health Care Provider Communication: A Mixed-Method Protocol. JMIR research protocols. 2015 04. 02
- 9 Adler-Milstein J, DesRoches CM, Furukawa MF, Worzala C, Charles D, Kralovec P, Stalley S, Jha AK. More Than Half of US Hospitals Have At Least A Basic EHR, But Stage 2 Criteria Remain Challenging For Most. Health Affairs. 2014 doi: 10.1377/hlthaff.2014.0453.
- 10 Adler-Milstein J, DesRoches CM, Kralovec P, Foster G, Worzala C, Charles D, Searcy T, Jha AK. Electronic health record adoption in US hospitals: progress continues, but challenges persist. Health Affairs. 2015 10.1377/hlthaff. 2015.0992..
- 11 DesRoches CM, Worzala C, Joshi MS, Kralovec PD, Jha AK. Small, nonteaching, and rural hospitals continue to be slow in adopting electronic health record systems. Health Affairs 2012; 31 (05) 1092-1099.
- 12 Berg M, Aarts J, van der Lei J. ICT in health care: sociotechnical approaches. Methods Archive 2003; 42 (04) 297-301.
- 13 Aarts J, Ash J, Berg M. Extending the understanding of computerized physician order entry: implications for professional collaboration, workflow and quality of care. International journal of medical informatics 2007; 76: S4-S13.
- 14 Pirnejad H, Niazkhani Z, Berg M, Bal R. Intra-Organizational Communicationin Healthcare. Methods of Information in Medicine. 2008 47. (i4).
- 15 National Nursing Practice Network. Available from: http://www.nnpnetwork.org/
- 16 Berwick DM. Launching accountable care organizations—the proposed rule for the Medicare Shared Savings Program. New England Journal of Medicine 2011; 364 (16) e32.
- 17 Care P-CP. Patient-Centered Medical Home. Senate Special Committee on Aging. 2007
- 18 Jha AK, DesRoches CM, Campbell EG, Donelan K, Rao SR, Ferris TG, Shields A, Rosenbaum S, Blumenthal D. Use of electronic health records in US hospitals. New England Journal of Medicine 2009; 360 (16) 1628-1638.
- 19 Charles D, Swain M, Patel V. Interoperability among US Non-federal Acute Care Hospitals. 2014: 2015.
- 20 Everson J, Lee S-YD, Friedman CP. Reliability and validity of the American Hospital Association’s national longitudinal survey of health information technology adoption. Journal of the American Medical Informatics Association 2014; 21 e2 e257-e263.
- 21 Gellert AGeorge, Ricardo R, Luke WS. Toward the Elimination of Paper Orders: Managing the Challenge of Low Frequency Physician Users of Computerized Patient Order Entry (CPOE). Appl Clin Inform 2016; 07: 33-42.
- 22 Patel N, Siegler JE, Stromberg N, Ravitz N, Hanson CW. Perfect Storm of Inpatient Communication Needs and an Innovative Solution Utilizing Smartphones and Secured Messaging. Appl Clin Inform 2016; 07 (03) 777-789 doi: 10.4338/ACI-2015–11-RA-0151..
- 23 Radley DC, Wasserman MR, Olsho LE, Shoemaker SJ, Spranca MD, Bradshaw B. Reduction in medication errors in hospitals due to adoption of computerized provider order entry systems. Journal of the American Medical Informatics Association 2013; 20 (03) 470-476.
- 24 Keenan G, Yakel E, Lopez KD, Tschannen D, Ford YB. Challenges to nurses’ efforts of retrieving, documenting, and communicating patient care information. Journal of the American Medical Informatics Association 2013; 20 (02) 245-251.
- 25 Kossman SP, Scheidenhelm SL. Nurses’ perceptions of the impact of electronic health records on work and patient outcomes. CIN: Computers, Informatics, Nursing 2008; 26 (02) 69-77.
- 26 Gagnon MP, Légaré F, Labrecque M, Frémont P, Pluye P, Gagnon J, Car J, Pagliari C, Desmartis M, Turcot L. Interventions for promoting information and communication technologies adoption in healthcare professionals. The Cochrane Library. 2009