Staff perspectives on the usability of electronic patient records for planning and delivering dementia care in nursing homes: a multiple case study

Abstract

Background: The electronic patient record (EPR) has been introduced into nursing homes in order to facilitate documentation practices such as assessment and care planning, which play an integral role in the provision of dementia care. However, little is known about how the EPR facilitates or hinders these practices from the end-user's perspective. Therefore, the objective of this qualitative study was to explore the usability issues associated with the EPR for assessment and care planning for people with dementia in nursing homes from a staff perspective. Methods: An exploratory, qualitative research design with a multiple case study approach was used. Contextual Inquiry was carried out with a variety of staff members (n = 21) who used the EPR in three nursing homes situated in Belgium, Czech Republic and Spain. Thematic analysis was used to code interview data, with codes then sorted into a priori components of the Health Information Technology Evaluation Framework: device, software functionality, organisational support. Two additional themes, structure and content, were also added. Results: Staff provided numerous examples of the ways in which EPR systems are facilitating and hindering assessment and care planning under each component, particularly for people with dementia, who may have more complex needs in comparison to other residents. The way in which EPR systems were not customisable was a common theme across all three homes. A comparison of organisational policies and practices revealed the importance of training, system support, and access, which may be linked with the successful adoption of the EPR system in nursing homes. Conclusions: EPR systems introduced into the nursing home environment should be customisable and reflect best practice guidelines for dementia care, which may lead to improved outcomes and quality of life for people with dementia living in nursing homes. All levels of nursing home staff should be consulted during the development, implementation and evaluation of EPR systems as part of an iterative, user-centred design process.

Implementation of eHealth to Support Assessment and Decision-making for Residents With Dementia in Long-term Care: Systematic Review

“…All studies included adults with dementia, focusing specifically on requirements for people with dementia (11/29, 38%) [ 31 , 32 , 38 - 40 , 43 , 47 , 49 , 50 , 53 , 54 ] or within a mixed population (18/29, 62%) [ 33 - 37 , 41 , 42 , 44 - 46 , 48 , 51 , 52 , 55 - 59 ]. The average percentage of residents with dementia was 52.8% in the mixed population studies that reported the proportion (6/29, 21%) [ 35 , 37 , 44 , 46 , 55 , 56 ].…”

“…eHealth is at an advantage if it aligns with data and technology already in use [ 37 , 40 , 51 , 52 ]. Concerns on patient privacy and electronic transfer of confidential information act as institutional firewalls [ 40 , 49 ] but can be overcome by encrypting data and assigning residents confidential numbers [ 49 ] . A way to increase the adaptability of a device is through the provision of customizable tools such as drop-down menus [ 40 ].…”

“…Concerns on patient privacy and electronic transfer of confidential information act as institutional firewalls [ 40 , 49 ] but can be overcome by encrypting data and assigning residents confidential numbers [ 49 ] . A way to increase the adaptability of a device is through the provision of customizable tools such as drop-down menus [ 40 ]. Incorporating a decision support system in eHealth interventions is advocated to respond to changes in individual residents’ needs by providing alerts and directing staff to appropriate care [ 40 , 48 , 55 ].…”

“…A way to increase the adaptability of a device is through the provision of customizable tools such as drop-down menus [ 40 ]. Incorporating a decision support system in eHealth interventions is advocated to respond to changes in individual residents’ needs by providing alerts and directing staff to appropriate care [ 40 , 48 , 55 ].…”

“…eHealth is more likely to be implemented if it is straightforward and user-friendly [ 36 - 38 , 40 , 41 , 44 , 45 , 47 , 48 , 53 , 54 , 56 , 58 ]. Simple devices are regarded as more reliable [ 36 , 40 , 48 ], and it is recommended that more advanced technology be used only where necessary [ 36 ].…”