Adoption of New Technology Systems
Nurses are not merely practitioners who dispense care to patients. They also constitute important agents of change in a hospital setting. The ability of a nurse to be able to apply advanced or modern technology to assist a patient reflects the degree of technological advancement in the entire facility. This paper describes the necessary background training that nurses should be given to make them fully prepared to implement a new electronic health records system. The first part of the paper discusses Everett Rogers’ (2003) theory of technology adoption and how it can help a nurse facilitator to prepare for the training. The second part of the paper describes the specific information or training activities that may be needed to address each aspect of Rogers’ five proposals. The last section will analyze the role of nurses as change agents, specifically on adoption of new technology.
Everett Rogers’ theory and approach to meeting with the nurses
Rogers (2003) argues that the rate of adoption of a technology is a product of many factors. One group of these factors is the perceived attributes of the innovation. According to Rogers (2003), such attributes include relative advantage, compatibility, complexity, trialability, and observability. The second category of factors is the type of decision involved, such as optional, collective or authority. The third major factor comprises the communication channels involved in the process of implementation of the innovation. The last two factors are characteristics of the social system, and the degree to which change agents exert effort in pushing for the adoption of the innovation.
In the first meeting with the nurses, the facilitator will make basic introductions of the new Electronic Health Records (EHR) system. The introduction will highlight basic concepts of EHR, the underlying federal and state law, and policies on the use of this innovation such as the HITECH Act, basic functions and expected benefits and the main steps in the implementation process of EHR. The facilitator will begin by justifying the hospital’s decision to implement the new EHR system. The facilitator will also inform the nurses about their responsibilities towards effective implementation of the system. The facilitator will then prepare them for official training on the applications of the EHR. Therefore, the main aim of the meeting will be to instill positive attitudes and a willingness to learn.
Information and activities to address each area of Rogers’ theory
Using the first category of factors, namely the perceived attributes of the innovation, a framework will be prepared to train the nurses on the potential benefits of the new electronic health records (EHR) system. In the first place, the nurses will need to know how the new EHR system will improve their work and the overall services in the facility compared to the existing system. To date, the hospital has been relying on old hardcopy filing system with minimal applications of computers. This system has not been reliable. The files are bulky, and retrieval of information has been slow. Most of the files have over the years become worn out leading to losses in patient records. The large paperwork has also led to great wastage of space in the form of filing rooms. Besides, most of the nurses admit that heavy paperwork has also rendered their services difficult to undertake. Therefore, the facilitator will make the nurses realize that EHR seeks to address many of the challenges that come with the collection, analysis, storage, access, retrieval and meaningful use of healthcare data. According to Silow-Carroll, Edwards, and Rodin (2012), EHRs have enhanced accuracy and speed of communication and streamlined hospital procedures. As a result, hospitals that use EHR report less duplicative processes, faster responses to patient needs, the exhaustive capture of charges and greater job satisfaction among nurses. Therefore, during training, the nurses will be helped to relate to these benefits.
On the issue of compatibility, the nurses will need to understand how the new EHR system will form a part of the existing values and practices of the healthcare facility. Quinn (2015) sees compatibility as the quality of innovations to not interrupt patient care. To help them on this issue, the facilitator will show the nurses how the new system will merge with the existing values and procedures in the hospital. The facilitator will also ask the nurses to suggest areas that may need to be reconfigured to ensure that the selected EHR system is compatible with existing technologies, values, services, human resource personnel, and physical structures. The selected EHR system will be hosted from a remote but dedicated server.
Moreover, on the issue of complexity, the nurses will be curious to know whether or not the new EHR will be easy to master and apply. They will need to feel competent in using the new system. The EHR training on competencies will explore basic computer skills, information literacy, and information management skills. Training on these three areas will correspond to the nature of software employed in the new EHR system and the areas or services of specialization of every nurse.
The best way to learn anything is through practical experience. Therefore, the nurses will also need to gain exposure by conducting trials with the new EHR. To this end, the facilitator will take them through a series of illustrations on how to apply the new EHR in data collection, storage, retrieval, analysis and meaningful use in patient care. After demonstrations, the nurses will be allowed to use the system on their own. The facilitator will then evaluate the nurses’ abilities to manipulate the EHRs on their own. This approach will constitute the training outcome from which the facilitator will be able to gauge changes in the level of knowledge on the EHR system and the attitudes towards its adoption.
Based on the final attribute in Rogers’ (2003) theory, namely observability, the nurses will ultimately need to witness for themselves that EHRs do yield observable results when applied to patient care. Consequently, at the completion of training, the facilitator, together with the implementation team, the hospital administration and the nurses, will begin to implement the new EHR system. A follow-up survey and on-site re-training will then be carried out to ensure that nurses are indeed witnessing the envisaged benefits of the innovation. These steps will also help the stakeholders to detect and address possible pitfalls early in the implementation stage of the EHR.
Responding to resistance
EHR as a form of innovation is already receiving resistance from some nurses. In most cases, resistance to innovations is driven by ignorance over the real benefits and potential losses of those innovations. Cochi (2014) advises that the key to overcoming resistance to adoption of technologies in hospitals is proper communication. Therefore, the training of the nurses will in part help rid some of the resistance. The facilitator will also allow the nurses time to air their respective concerns over the new technology. The facilitator will then address each of these grievances separately to allay the concerns of every nurse.
Nurses as change agents in adoption of new technology
Hospitals operate as organizations, and nurses provide the front services of most of these organizations. As such, when it comes to innovations such as the EHRs, nurses should be at the frontiers of adoption. However, nurses may not rush to adopt such systems without the support of management. Silow-Carroll et al. (2012) propose that effective adoption of EHRs depends on management support, engagement of nurses in design and implementation, training of nurses on relevant competencies and faithfulness to set timelines and financial allocations. Nurses play an important role in the interfaces of the patients, doctors, laboratory technicians, chemists and medical cover providers (Kumar, 2014). They support the doctors with information while helping to educate patients about their condition, processes and hospital administrative procedures. Consequently, training nurses to be able to manipulate EHRs will enhance the implementation of the system. The nurses will be able to enter accurate information to be accessed by other sections of the hospital. They will also be able to rely on accurate and up-to-date information to counsel patients and respond to patient needs.
Conclusion
Nurses are important pillars to functional EHR systems in hospitals. They are responsible for inputting patient data into these systems. These data will aid many other services within a hospital setting. The support services that nurses provide to both the patients and the rest of the practitioners places them at a unique position in the implementation of the EHRs. Consequently, nurses must be helped to become competent in EHRs. These systems exist in different configurations, and it is important for every nurse to be able to operate all of them.
References
Cochi, R. (2014, March 25). Physician resistance to EHR systems and how to overcome it. Healthcare Business & Technology. Retrieved June 8, 2017, from http://www.healthcarebusinesstech.com/ehr-systems-resistance/
Kumar, R. (2014). Electronic Health Records: An Introductory Course. RN.com. AMN Healthcare Education Services.
Quinn, R. (2015, February 20). Compatibility Issues Make Physicians’ Use of Electronic Health Records Systems Tougher. The Rheumatologist. Retrieved June 8, 2017, from http://www.the-rheumatologist.org/article/compatibility-issues-make-physicians-use-of-electronic-health-records-systems-tougher/
Rogers, E. M. (2003). Diffusion of Innovations (5th ed.). New York: The Free Press.
Silow-Carroll, S., Edwards, J. N., & Rodin, D. (2012). Using Electronic Health Records to Improve Quality and Efficiency: The Experiences of Leading Hospitals. Commonwealth Fund pub. 1608, 17, 1-39.
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