The role of Electronic Patient Records (EPR) for planning and delivering dementia care in nursing homes

Abstract

Nursing homes face a multitude of challenges including documentation pressures. Adequate documentation plays an important role in the planning and delivering of care, particularly for those living with dementia. The electronic patient record (EPR) has been introduced into nursing homes in order to facilitate documentation practices. However, little is known about how the EPR facilitates or hinders assessment and care planning for people with dementia from the end user’s perspective. A multiple case study using the Contextual Inquiry method was carried out in order to explore usability issues associated with the EPR in nursing homes in Belgium, Czech Republic and Spain. Thematic analysis was used to code data according to a priori components of the Health Information Technology Evaluation Framework: device, software functionality, organisational support. Two additional themes, structure and content, were also added. Participants provided a range of examples of how the EPR is facilitating or hindering assessment and care planning under each component, particularly for people with dementia, who may present with more complex needs. On the basis of this research, good practice principles were developed: EPR systems introduced into the nursing home environment should be customisable and reflect best practice guidelines for dementia care; all levels of nursing home staff should be consulted during the development, implementation and evaluation of EPR systems as part of an iterative, user-centred design process; portable and unobtrusive devices for electronic records are optimal for staff and residents; applications promoting the effective use of electronic records are required; functionalities of electronic records should be tailored to the nursing home environment; electronic care documentation should meet the needs both of people with dementia, and staff caring for them; nursing home managers should ensure the appropriate conditions for implementation of EPR systems.