While nurses are often involved during testing and as super users for training and support, this is generally too late to have any meaningful input into the usability or content of the selected system. There is great potential for EMRs to streamline workflows, reduce errors, duplication and of course reduce time spent on administration. However to realise these benefits the end user needs to have more involvement at the earlier stages of IT projects, in particular with system procurement and design.

A survey completed for the Royal College of Nursing (RCN) in the UK found that technology, if not used properly can actually increase the workload of nursing staff and over two-thirds of respondents said that the use of Information Technology has increased the amount of time they spend on paperwork and administration (1). This is not good news for an already overstretched health system where on a recent work-to-rule in a Dublin hospital, nurses withdrew from admin work to concentrate on direct patient care.  

For a system to be effective, user friendly and adapt to the workflow of the end user, it seems obvious to include their input at the early stages. Nurses represent the largest group of front line staff that will use EMRs, however, 98% of nurses surveyed in US hospitals agree that they have never been included in hospital technology decision or design. Only 15% of those surveyed thought that their IT department were receptive to nurses’ suggestions in improving electronic documentation (2).