The Introduction of an Electronic Patient Care Information System and Health Care Providers’ Job Stress: A Mixed-Methods Case Study

Introduction

Health care organizations frequently introduce innovations in health care delivery as they strive to provide safer and more cost effective services (Poissant, Perieria, Tamblyn & Kawasumi, 2005; Chaudhry, Wang, Wu, Maglione, Mojica, et al., 2006; Menachemi & Brooks, 2006; Sidorov, 2006). For health care providers (HCPs), innovations and the subsequent organizational change may be disruptive and intrusive as it upsets the balance of their already unpredictable and complex work day. While innovations are often judged primarily by evaluating their impact on patient care (Van Der Medijden, Tange, Troost & Hasman, 2003) or health care costs (Menachemi & Brooks, 2006; Sidorov, 2006), less research has assessed the impact of health care innovations on HCPs’ attitudes or work experiences (Anderson & Balas, 2006; Liang, Xue & Wu, 2006; O’Neill, Talbert & Klepack, 2009; Wager, Zoller, Soper, et al., 2008). The technology acceptance model, derived from the theory of planned behavior, proposes that when a technology is believed to be less effective, less advantageous and/or more difficult to use, HCPs will hold more negative attitudes towards the technology and are less likely to use it (Ilie, Van Slyke, Courtney & Styne, 2009; Liang et al., 2006; Sittig, Kuperman & Fiskio, 1999; Trimmer, Cellucci, Wiggins & Woodhouse, 2009; Wager et al., 2008). In this study, we adopt a mixed-methods case study approach to assess the impact of the introduction of an electronic Patient Care Information System (PCIS) as part of the electronic health record (EHR) on the job stress of HCPs working on a single medical unit.

The term electronic health record refers to a paperless form of a patient’s medical record where HCPs can enter and retrieve information utilizing a computerized system rather than writing in a paper chart. An EHR can be comprehensive, interfacing with other health care information systems from departments such as pharmacy, diagnostic imaging and laboratory services, allowing HCPs direct access to diagnostic results and treatment options. EHRs with computerized physician order entry (CPOE) capabilities allow physicians and other HCPs to manage medical orders collaboratively and inter-professional communication tools, such as electronic messaging systems, can be incorporated. EHRs may also bridge geography by providing access to patient information and linking independent sites in the retrieval of stored information from previous patient encounters in primary care or acute and ambulatory care settings.