Abstract
Unintended consequences of electronic health records represent undesired effects on individuals or systems, which may contradict initial goals and impact patient care. The purpose of this study was to determine the extent to which a new quantitative measure called the Carrington-Gephart Unintended Consequences of Electronic Health Record Questionnaire (CG-UCE-Q) was valid and reliable. Then, it was used to describe acute care nurses' experience with unintended consequences of electronic health records and relate them to the professional practice environment. Acceptable content validity was achieved for two rounds of surveys with nursing informatics experts (n = 5). Then, acute care nurses (n = 144) were recruited locally and nationally to complete the survey and describe the frequency with which they encounter unintended consequences in daily work. Principal component analysis with oblique rotation was applied to evaluate construct validity. Correlational analysis with measures of the professional practice environment and workarounds was used to evaluate convergent validity. Test-retest reliability was measured in the local sample (N = 68). Explanation for 63% of the variance across six subscales (patient safety, system design, workload issues, workarounds, technology barriers, and sociotechnical impact) supported construct validity. Relationships were significant between subscales for electronic health record-related threats to patientsafety and low autonomy/leadership (P < .01), poor communication about patients (P < .01), and low control over practice (P < .01). The most frequent sources of unintended consequences were increased workload, interruptions that shifted tasks from the computer, altered workflow, and the need to duplicate dataentry.Convergent validity of the CG-UCE-Q was moderately supported with both the context and processes of workarounds with strong relationships identified for when nurses perceived a block and altered process to work around it to subscales in the CG-UCE-Q for electronic health record system design (P < .01) and technological barriers (P < .01).
| Original language | English (US) |
|---|---|
| Pages (from-to) | 436-447 |
| Number of pages | 12 |
| Journal | CIN - Computers Informatics Nursing |
| Volume | 34 |
| Issue number | 10 |
| DOIs | |
| State | Published - Oct 1 2016 |
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Keywords
- Barrier
- Electronic health record
- Electronic medical record
- Measurement
- Nursing
- Nursing informatics
- Patient safety
- Professional practice environment
- Psychometric analysis
- Unintended consequences
- Workaround
ASJC Scopus subject areas
- Health Informatics
- Nursing (miscellaneous)
Cite this
Validity and reliability of a new measure of nursing experience with unintended consequences of electronic health records. / Gephart, Sheila M; Bristol, Alycia A.; Dye, Judy L.; Finley, Brooke A.; Carrington, Jane M.
In: CIN - Computers Informatics Nursing, Vol. 34, No. 10, 01.10.2016, p. 436-447.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Validity and reliability of a new measure of nursing experience with unintended consequences of electronic health records
AU - Gephart, Sheila M
AU - Bristol, Alycia A.
AU - Dye, Judy L.
AU - Finley, Brooke A.
AU - Carrington, Jane M
PY - 2016/10/1
Y1 - 2016/10/1
N2 - Unintended consequences of electronic health records represent undesired effects on individuals or systems, which may contradict initial goals and impact patient care. The purpose of this study was to determine the extent to which a new quantitative measure called the Carrington-Gephart Unintended Consequences of Electronic Health Record Questionnaire (CG-UCE-Q) was valid and reliable. Then, it was used to describe acute care nurses' experience with unintended consequences of electronic health records and relate them to the professional practice environment. Acceptable content validity was achieved for two rounds of surveys with nursing informatics experts (n = 5). Then, acute care nurses (n = 144) were recruited locally and nationally to complete the survey and describe the frequency with which they encounter unintended consequences in daily work. Principal component analysis with oblique rotation was applied to evaluate construct validity. Correlational analysis with measures of the professional practice environment and workarounds was used to evaluate convergent validity. Test-retest reliability was measured in the local sample (N = 68). Explanation for 63% of the variance across six subscales (patient safety, system design, workload issues, workarounds, technology barriers, and sociotechnical impact) supported construct validity. Relationships were significant between subscales for electronic health record-related threats to patientsafety and low autonomy/leadership (P < .01), poor communication about patients (P < .01), and low control over practice (P < .01). The most frequent sources of unintended consequences were increased workload, interruptions that shifted tasks from the computer, altered workflow, and the need to duplicate dataentry.Convergent validity of the CG-UCE-Q was moderately supported with both the context and processes of workarounds with strong relationships identified for when nurses perceived a block and altered process to work around it to subscales in the CG-UCE-Q for electronic health record system design (P < .01) and technological barriers (P < .01).
AB - Unintended consequences of electronic health records represent undesired effects on individuals or systems, which may contradict initial goals and impact patient care. The purpose of this study was to determine the extent to which a new quantitative measure called the Carrington-Gephart Unintended Consequences of Electronic Health Record Questionnaire (CG-UCE-Q) was valid and reliable. Then, it was used to describe acute care nurses' experience with unintended consequences of electronic health records and relate them to the professional practice environment. Acceptable content validity was achieved for two rounds of surveys with nursing informatics experts (n = 5). Then, acute care nurses (n = 144) were recruited locally and nationally to complete the survey and describe the frequency with which they encounter unintended consequences in daily work. Principal component analysis with oblique rotation was applied to evaluate construct validity. Correlational analysis with measures of the professional practice environment and workarounds was used to evaluate convergent validity. Test-retest reliability was measured in the local sample (N = 68). Explanation for 63% of the variance across six subscales (patient safety, system design, workload issues, workarounds, technology barriers, and sociotechnical impact) supported construct validity. Relationships were significant between subscales for electronic health record-related threats to patientsafety and low autonomy/leadership (P < .01), poor communication about patients (P < .01), and low control over practice (P < .01). The most frequent sources of unintended consequences were increased workload, interruptions that shifted tasks from the computer, altered workflow, and the need to duplicate dataentry.Convergent validity of the CG-UCE-Q was moderately supported with both the context and processes of workarounds with strong relationships identified for when nurses perceived a block and altered process to work around it to subscales in the CG-UCE-Q for electronic health record system design (P < .01) and technological barriers (P < .01).
KW - Barrier
KW - Electronic health record
KW - Electronic medical record
KW - Measurement
KW - Nursing
KW - Nursing informatics
KW - Patient safety
KW - Professional practice environment
KW - Psychometric analysis
KW - Unintended consequences
KW - Workaround
UR - http://www.scopus.com/inward/record.url?scp=84983349240&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84983349240&partnerID=8YFLogxK
U2 - 10.1097/CIN.0000000000000285
DO - 10.1097/CIN.0000000000000285
M3 - Article
C2 - 27551947
AN - SCOPUS:84983349240
VL - 34
SP - 436
EP - 447
JO - CIN - Computers Informatics Nursing
JF - CIN - Computers Informatics Nursing
SN - 1538-2931
IS - 10
ER -