An integrative review exploring the impact of Electronic Health Records (EHR) on the quality of nurse-patient interactions and communication.
Carol Forde-Johnston, Dan Butcher, Helen Aveyard
PMID 36345050WHAT IT FOUND
Nurses using electronic health records often let checklists and screens interrupt patient conversation, but some turn the screen toward the patient to share information.
Effects on person-centred care were mixed.
Key findings
01Observed nurse consultations often shifted attention to the computer screen or checklist, interrupting face-to-face communication.
02Some nurses used the EHR screen to share up-to-date information and support patient-centred communication.
03Time and motion studies gave inconsistent results: documentation increased, while patient-room and purposeful interaction time either increased or did not significantly change.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only eight studies from the United States, United Kingdom and Australia were included, so the review does not show what happens in other health systems. No included study measured nurse-patient communication before EHR introduction, so the review cannot show that EHR alone caused the changes. Many findings are nurses' perceptions or observed behaviours, not patient clinical outcomes, and the authors note perceptions cannot be verified without a before-after study. The studies used different designs, devices and settings, and time-and-motion results moved in different directions. The authors appraised quality but excluded no studies, and gave greater weight to stronger papers rather than a formal synthesis.
Declared interests
The review was funded by the NIHR Oxford Biomedical Research Centre and the NIHR Thames Valley Comprehensive Local Research Network. The authors declared no conflict of interest.
The easy way to misread this
Do not conclude that electronic health records necessarily worsen nurse-patient communication. The review included only eight studies, none compared interaction before and after EHR, and some nurses used the screen to support patient-centred communication.