Electronic Health Records Implementation: Research Design

Literature Review

The emergence of health IT is completely transforming how patients are offered care in health institutions. According to Boonstra, Versluis, and Vos (2014), technology is rapidly transforming the healthcare sector, as new tools and equipment emerge meant to improve speed, efficiency, and experience of care delivery. Technology is making it simple and more consistent when it comes to taking care of patients than was the case in the past.

The use of the manual system is being replaced with automated systems as a way of improving the entire healthcare system. Medical experts and engineers have been working very closely to find ways of coming up with state-of-the-art technologies, which are capable of improving the entire healthcare system. Studies suggest that through this close partnership between medical experts and engineers, it has been possible to develop systems that make it easy to diagnose various diseases accurately, enter and process patients’ data, and offer them quality healthcare services. One of the emerging technological systems in the healthcare sector that are gaining popularity and relevance in modern society is electronic health records (EHRs).

According to Silow-Carrol, Edwards, and Rodin (2012), electronic health records came at a time when nurses were under great pressure in the United States. The number of patients seeking medical care in the country has been on the rise. Jha et al. (2009) attribute the rising cases of those who seek medical care to the emerging lifestyle diseases such as diabetes, coronary diseases, and obesity among others.

The rising population, especially the undocumented immigrants, in the country also means that a lot more is expected of medical practitioners. However, the government has not been employing nurses at the same rate as the rising demand for their services. Nurses find themselves often overstretched in their work. The emergence of EHRs came as a reprieve to the nurses because it has eliminated the need to have physical files, which were time-consuming when it came to taking, processing, storing, and sharing patients’ data. The new system makes it easy to manage patients’ data once it is recorded at various stages of diagnosis and treatment.

The time that nurses had to spend moving from one place to another within the hospitals transferring patients’ data can be used in other activities. Cases of lost or misplaced files have also been eliminated.

According to Friedman et al. (2013), EHRs systems have not only benefited the nurses but also the medical doctors. A lot of time would be lost physically looking for the patients’ file or making new records in case they are lost. Such cases have been eliminated. They can now share patients’ information with ease. The relationship between nurses and doctors has also improved. Middleton, Bloomrosen, and Dente (2013) say that the delays in file delivery would often strain such relationships.

On one hand, the doctors would feel nurses are less competent in handling the files hence they end up wasting valuable time that would have been used in undertaking other activities. On the other hand, the nurses would feel frustrated when doctors pressure them at a time when they feel the system used to store files is not effectively functional. That is why EHRs have come out as a very important system that helps in improving the coordination between nurses and doctors.

According to Friedman et al. (2013), a section of the nurses has registered their disapproval of the design of this technology despite its obvious benefits. Some of these nurses feel that the new system failed to take into consideration some of their needs when offering care to patients. For instance, it is important to ensure that the system is capable of capturing information about a specific nurse who entered or handled patients’ records at any given time.

This requirement helps in enhancing responsibility among nurses who are handling patient records. Mistakes committed to entering or processing patients’ data may have serious consequences on the health of the patient. It will defeat the very goal of the new technology that seeks to make the patients safer and to offer them superior healthcare services. Then there is the threat of a cyber-attack. Cybercriminals can access and manipulate online data, which may lead to a serious misinterpretation of patients’ conditions and needs. It may result in a case where the wrong medication is offered to the patient. It is important to find a way of addressing such legitimate concerns. The new system has superiority over the manual system in terms of the speed of recording and handling patients’ data. Addressing these concerns may help in improving patients’ safety.


The study focuses on the relevance of the EHRs system in modern healthcare institutions and the challenges associated with it, which need to be addressed to make it more efficient and effective. The method used in this study must help in answering the set research questions in clear terms. The methodology must facilitate the process of collecting the desired data (both primary and secondary data), processing the data, and its presentation in a way that answers the research questions. In this section of the paper, the researcher will describe the methodology that was used to guide the entire process of data collection, analysis, and presentation.

Research Design

According to Fowler (2013), one of the first steps, that a researcher should take when planning to conduct research is to come up with a research design. The design must be appropriate for a study. The chosen research design will be descriptive. The study seeks to find out whether the EHRs system has a positive or negative impact on patients. Through descriptive studies, it will be possible to analyze challenges that affect the implementation of the EHRs system and how these challenges can be addressed. The design will also make it easy to capture the patients’ feelings towards the use of this system as opposed to the use of the manual systems. The respondents will be allowed to explain, in their own words, how the EHRs can be improved to enhance the quality it delivers to the patients.

Inductive reasoning

The researcher opted to use inductive reasoning in this study. Electronic health records system is a new technology that is meant to enhance service delivery to patients. Despite its obvious benefits, a section of the nurses feels that it has some fundamental flaws that should be addressed to enhance patient safety. This study will use inducting reasoning to come up with new knowledge (not necessarily a theory) that can be used to enhance the use of EHRs in healthcare institutions. It will start by observing how the system works, determining a pattern of its functionality, developing a tentative hypothesis on how to make it more efficient, then coming up with a new knowledge based on the analysis of data on how the system can be made more efficient in service delivery.

Flow-map of inducting reasoning.
Figure 1: Flow-map of inducting reasoning.

Sampling Method

When planning to collect primary data from respondents, Kara (2015) advises that it is important to take into consideration time and available resources before coming up with the appropriate sample size. In this study, the information needed had to be collected from the nurses. Given that this is academic research with a strict budget and a specific time within which it has to be completed, it was necessary to come up with manageable sample size. A sample size of 50 nurses was considered manageable given the tight budget and timeline available for the study. Several healthcare centers where the EHRs system is in use were selected to participate in the study. Nurses in these participating institutions were selected using a simple random sampling method.

Data Collection Tools

Secondary data was collected from books, journal articles, and other reliable online sources. Primary data was collected from the sampled 50 nurses in the selected institutions. As Fowler (2013) notes, it is important to develop proper tools for data collection in advance before embarking on the actual process of collecting data. The researcher developed a questionnaire that was used to collect data from the respondents. The questionnaire captured the academic qualifications of the respondents, their experience in using both the manual and EHRs systems and the research questions focused on achieving the goal of this study.


Boonstra, A., Versluis, A., & Vos, J. (2014). Implementing electronic health records in hospitals: A systematic literature review. BMC Health Services Research, 14(370), 1-24.

Fowler, F. J. (2013). Survey research methods. New York, NY: SAGE Publications.

Friedman, A., Crosson, J., Howard, J., Clark, E., Pellerano, M., Kash, B.,… Cohen, D. (2013). A typology of electronic health record workarounds in small-to-medium size primary care practices. Journal of American Medical Information Association, 21(1), 78-83.

Jha, A., DesRoches, C., Campbell, E., Donelan, K., Sowmya, R., Ferris, T.,… Blumenthal, D. (2009). Use of electronic health records in U.S. hospitals. The New England Journal of Medicine, 36(16), 8-38.

Kara, H. (2015). Creative research methods in the social sciences: A practical guide. London, UK: Policy Press.

Middleton, B., Bloomrosen, M., & Dente, M. (2013). Enhancing patient safety and quality of care by improving the usability of electronic health record systems: Recommendations from AMIA. J Am Med Inform Assoc, 20(1), 2-8.

Silow-Carrol, S., Edwards, J., & Rodin, D. (2012). Using electronic health records to improve quality and efficiency: The experience of leading hospitals. The Commonwealth Fund Publications, 17(1), 1-39.

Tracy, S. J. (2013). Qualitative research methods: Collecting evidence, crafting analysis, communicating impact. Chichester, UK: Wiley-Blackwell.