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Why do Most Nurses Dislike their EHR? Take One Guess

October 29, 2014
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I’m not a man of daily routine, but there is one thing I try to do every night. At 7 p.m., I try to watch Jeopardy!

I know it’s corny, but it’s something I’ve been doing since I was a kid. Growing up, my mom and I used to watch it all the time and I’d marvel at how she’d get every single question right. Watching the show now as an adult makes me feel close to Mom, even while she is in Boston and I’m in New York.

Lately, it’s been nearly impossible to watch Jeopardy! (true fans know you never exclude the exclamation point). It’s nothing that Alex Trebek and company have done. No, it’s because we are in the midst of midterm election season and every race in New York, New Jersey, and Connecticut has decided to ramp up the advertisements from 7 p.m. to 7:30. I can’t watch Jeopardy! without seeing why Candidate A is going to cause the end of the world. Paid for by Candidate B, of course.

Whether you’re a Democrat, Republican, or independent, public anger is at an all-time high and those who are up for election next Tuesday are taking advantage.  Every commercial is nauseatingly exploitative of the issues at hand: healthcare, the economy, gun control, women’s rights, ISIS. It’s all an effort to tap into our feelings of anger.

Liberals dislike conservatives and vice versa. We dislike politicians. Politicians dislike each other. We hate advertisements. People are frustrated with the President. A poll from CNN found that more than anything else, anger is driving the midterm elections.

Yes, October is the month of anger. It’s not just due to election season. It’s everywhere. I recently found myself caught in a nasty argument between two tweeters after I wrote something that I thought was innocuous on Ebola.

As I said a few weeks ago, people want to blame someone or something over the Ebola situation. Why? It’s frustrating and disconcerting and ultimately, is out of our control. It’s easy to get upset. And just like everything else, it doesn’t help that it gets exploited by politicians and mainstream media members.

Of course, this anger has seeped into the health IT world. This comes as no surprise. In a popularity poll of doctors, I bet meaningful use would fare as well as Congress has in the court of public opinion. My wife told me that when she went to the doctor’s office recently, he railed on meaningful use and electronic health records (EHRs) after she revealed to him what I did.

Recently, New York-based Black Book Research polled nearly 14,000 licensed registered nurses from forty states, all utilizing implemented hospital EHRs over the last six months. Ninety-percent percent of them express dissatisfaction with their inpatient EHR system. Eighty-four percent of those polled said that EHRs causing disruptions in productivity and workflow have negatively influenced their job satisfaction.

An amazing 69 percent of nurses in for-profit inpatient settings say their IT department is incompetent. That number shocks me but I guess it shouldn’t. IT departments are under more scrutiny than ever. One false step and you’ll end up like the leaders at Athens (Ga.) Regional Health Systems.

I’ve known for a while that most doctors are like my wife’s: They’re just not big fans of EHRs. A new survey from the Medical Group Management Association (MGMA) shows that they are also not fans of federal reporting programs, like meaningful use. Again, this was not a big shocker.

Nurses? I always figured they were more ambivalent toward EHRs and health IT in general. I have a few friends that are nurses and none of them ever said anything disparaging about them. I was wrong because 14,000 people do not constitute a small sample size.

So what’s the solution to this anger? Every situation is different, but let me point you to a key finding of the Black Book study. Ninety-eight percent of nurses said they were not included in the development of their inpatient EHR.

That is unacceptable. If nurses are going to use it, they should be included in the development process. Successful IT leaders always talk to us about the importance of physician buy-in and having stakeholders involved from the get go, but what about nurses? That cannot be overlooked. It seems ridiculous to have to even say.

Nurses are angry with their EHRs for the same reason the public is so upset over a disease that has a slim chance of affecting them. It’s something that goes beyond our control. When you add in an exploitative element or two then it’s no wonder why October is the month of anger.

Please feel free to respond in the comment section below or on Twitter by following me at @GabrielSPerna



While I appreciate Mr. Perna's blog comments I have a slightly different perspective. I have been involved with several EPIC installs and the project team does include Nurses (CNO, RN's, Managers) as stakeholders or decision makers. As an RN who has crossed over into IT I am well aware of the priority of the RN. Their main focus is the patient and transitioning to an EMR seems to take away that priority. The truth seems to be, that regardless of Nurses input into build and workflow decisions, the project team gets the blame.

Change management needs to happen early in the process and buy in starts from the CNO down to the staff RN's. Adequate training needs to occur months in advance and a change of thinking at the bedside needs to occur.

Julie Crow, RN, MBA

Thanks for sharing your perspective Julie. Always good to hear from someone who has been involved at both sides. Do you think EMR systems are not user-friendly for nurses in general? Or is it not a technological problem, but more of a theoretical, cultural issue, as you sort of suggest at the end?

Mr. Perna I only know the EPIC software and I think it is fairly user friendly for both RN's and Physician's. I know the expectation is that the EMR is to mimic the paper chart and while the sole intention of workflow design is exactly that, it will not always be the case. Culturally, as stated, this is where the issue presents itself. The project team does have a responsibility to the stakeholders to ensure a smooth transition but it is a process that has to happen over time not overnight.

Julie Crow, RN, MBA

Whatever EHR you are using, what I have seen is that the end users (nurses) are not given any kind of training in using the EHRs. EHRs are selected and then implemented without taking any feedback or suggestions from the nurses. The rising dissatisfaction has led to the increasing rate of EHR switch in the 2014.

Thanks for the comment Alex. Sounds like training is one of the big issues at hand.


I greatly disagree with your statement and this is not the majority. I will tell you that at the time of selection of the chosen EMR you are correct staff RN's are most likely not involved in the selection of the EMR for various reasons. At each organization that I have installed EPIC, RN's (Managers, Directors, etc) have quite the say and input when it comes to design, build, and worklfows. One of the issues that I have seen is when an organization takes the model or foundation system build and if this is the case optimization of that build will come after go-live where the RN's input/decisions are needed and valued.

Julie Crow, RN, MBA

I am an RN and have been for 34 years, the last 6 in the roll of hospital nursing informatics. I agree that the front end users are key stakeholders. They ARE included in the design, testing, education, and implementation of every part of the EHR. They help with all aspects of the workflow process and development. The opportunity for participation in development and implementation is always available but the nurses need the desire and time to participate. If they do not participate then it is easy to see how they might take the perception that this was just forced on them with no input, when infact they chose not to be part of the development process. Many spend more time creating work arounds than learning the workflow and "key tricks" that they can use to actually increase their productivity without compromising the safe environment for delivery of care.

Thanks for sharing. Glad to hear more nurses are involved in the process. The fact that 98 percent said they weren't definitely raised my eyebrow. Would love to see some follow-up studies.

Finding the right EHR as a nurse practitioner can be difficult. I see that many have commented on only the negative things in the above comments. I would like to say that most EHR's will have negative aspects, but there were will be ones that have positive attributes as well. I recommend checking out drchrono, it has been customizable to my needs and has a relatively easy workflow.