Impact Of Electronic Health Record Research Articles

Electronic Health Record Adoption and Its Effects on Healthcare Staff: A Qualitative Study of Well-Being and Workplace Stress

Adopting electronic health records (EHRs) offers improved communication and information sharing and reduces medical staff errors. Despite these potential benefits, EHR adoption often introduces new challenges for healthcare staff, including increased administrative burdens and workplace stress. This study examines the impact of EHR systems on the well-being and workplace stress of healthcare staff in a hospital setting. Using a qualitative multi-perspective research approach, 16 guideline-based interviews were conducted to explore experiences, insight, and perceptions surrounding the anticipated introduction of EHRs. Data analysis reveals a complex interplay between the perceived advantages of EHRs, such as improved data accessibility and patient safety, and the challenges related to increased workload. Based on interviewers’ perceptions, emerging themes were categorized as technostress creators or inhibitors. The findings highlight a dual impact of EHRs: while participants acknowledged improvements in patient safety and information access, they also expressed concerns about increased workload, technostress, and potential disruptions to team dynamics. This study identified two major themes: “EHR Adoption as a Double-Edged Sword” and “EHRs’ Influence on Professional Dynamics”. These findings underscore the need for organizational readiness and staff support to mitigate the negative impacts of EHRs on healthcare workers’ well-being and job satisfaction.

Impact of EHRs on Nursing Burnout in a Hospital Setting in Saudi Arabia: Mixed-Methods Study.

This study explores the association between nursing burnout and Electronic Health Record (EHR) use in a Saudi Arabian hospital adopting an advanced EHR system. Utilising a mixed-methods approach, the research combines quantitative analysis of 282 survey responses and qualitative interviews from 21 registered nurses. Despite high EHR acceptance, negative perceptions and stress related to EHR use were identified. Findings indicate a weak link between EHR use and burnout, with resilience acting as a mitigating factor. Specific stressors, including documentation workload and usability issues, were countered by individual and organisational resilience. The study introduces a novel conceptual model emphasising the pivotal role of resilience at both levels in mitigating EHR-related burnout. Recommendations include fostering resilience-building strategies in EHR implementation processes and usability to prevent burnout, emphasising self-care practices, promoting work-life balance, and improving health information infrastructure.

An emperical Investigation into the impact of Electronic Health Records on Healthcare Quality and Patient Safety

The transformative impact of Electronic Health Records (EHRs) on healthcare quality in Saudi Arabia is the main focus of this study. The study examines how to implement EHRs to improve communication, make educated decisions, and ensure patient safety. It also discusses the advantages of doing so, including increased data accessibility and cost effectiveness. Issues with security and data interoperability are looked at concurrently. The study attempts to offer perceptive viewpoints on how the healthcare industry is changing while emphasizing how EHRs might improve overall quality control. As could be seen from above table, there is a positive and significant association between the all the variables under study. Hence our first two hypotheses have been substantiated. This means investing on training program could enhance quality as well as patient safety. Likewise, provision of best infrastructure also needs huge amount of financial resources. It could be seen from the result in table 2 that EHRs explained 26% variance in enhancing HCQ in Saudi healthcare system. Goodness of fit F= 277.112 found significant at p< 0.000. This implies that one percent investment in EHR cold increase HCQ by 51.4%. Likewise, the R2 for PST was recorded as .160 with F value 211.911 significant at 0.000, similarly for EHS, R2 was found as 0.121& with F value 292.820 significant at 0.000, all this led us to accept our hypothesis.

Impact of Electronic Health Records on Patient Confidentiality, Measuring the Perception of Health Care Professionals in Eastern Saudi Arabia

Impact of Electronic Health Records on Patient Confidentiality, Measuring the Perception of Health Care Professionals in Eastern Saudi Arabia

Clinicians' Attitudes Toward Electronic Health Records in Saudi Arabia.

This study explored physicians' and nurses' attitudes towardan electronic health record (EHR) system and examined the features and factors that clinicians associated with the implementation of EHR systems. A self-administered anonymous questionnaire with high reliability and validity was adopted from existing research to gather clinicians' attitudes towardthe EHR system implemented at King Khalid UniversityHospital, one of the biggest hospitals in Riyadh, Saudi Arabia. A total of 438 questionnaire responses were received from the participants; 240 of them were physicians and 198 were nurses. The participants had a mean age of 43.7 years (standard deviation (SD) 17.1), 213 (52.7%) were femaleand 207 (47.3%) were male. Most participants (424, 96.8%) had one or more years of experience using computers, and a majority (304, 69.4%) had one or more years of experience using EHR systems.Most physicians and nurses (214, 89.5%vs. 174, 87.9%) were satisfied with their hospital's EHR systemand felt that the system was highly usable and had the potential to improve communication between staff, facilitate easy storage of and access to informationand lead to improved health outcomes for patients. The study found positive attitudes among clinicians concerning the quality of training and education around the new system (178, 74.2%of physiciansvs. 142, 71.7%of nurses; p > 0.05) and towardleadership during the transition to HER (222, 92.5%vs. 183, 92.4%). On the other hand, a majority of nurses reported that the EHR system took longer to use and increased their workload compared with the previous analogue system (115 (47.9%) vs. 133 (67.2%); p ≤ 0.01and 46.7% vs. 112 (64.1%)). A large majority of physicians and nurses surveyed (214(89.2%) vs. 167 (84.3%)) stated that clinicians should be consulted in the design of such systems as a way to maximise the potential benefits of EHRand mitigate extra workload demands. Most clinicians expressed overall satisfaction with the EHR system, but there were some areas of dissatisfaction among the respondents, such as increasing workload and stress among nurses. There is scope for further research to continue to explore physicians' and nurses' attitudes towardEHRsand for future experimental studies that examine the impact of EHRs on clinician workloads, patient health outcomesand quality of care.

The impact of electronic health records on patient care and outcomes: A comprehensive review

Electronic Health Records (EHRs) have revolutionized healthcare delivery, offering numerous benefits for patient care and outcomes. This comprehensive review examines the impact of EHRs on patient care and outcomes, highlighting key findings from existing literature. EHRs have significantly improved patient care by enhancing accessibility and accuracy of patient information. With EHRs, healthcare providers can easily access patient records, including medical history, medications, and lab results, leading to more informed decision-making and improved coordination of care. EHRs also facilitate communication among healthcare providers, enabling better care coordination and reducing medical errors. Moreover, EHRs have been shown to improve patient outcomes by supporting evidence-based practices and clinical decision-making. EHRs can provide alerts and reminders for preventive care and screenings, helping healthcare providers adhere to best practices and guidelines. Additionally, EHRs enable real-time monitoring of patient data, allowing for early detection of potential health issues and timely interventions. Despite these benefits, challenges remain in the implementation and use of EHRs. Issues such as interoperability, data security, and provider burnout need to be addressed to fully realize the potential of EHRs in improving patient care and outcomes. In conclusion, EHRs have had a transformative impact on patient care and outcomes, improving accessibility, accuracy, and coordination of care. However, ongoing efforts are needed to address challenges and ensure the effective use of EHRs in healthcare delivery.

67. Examining the Impact of Electronic Health Records on Adolescent Healthcare Communication and Self-Efficacy

67. Examining the Impact of Electronic Health Records on Adolescent Healthcare Communication and Self-Efficacy

Electronic health record impact on data quality: An integrated review

Few studies have assessed the impact of Electronic Health Record (EHR) on data quality and how it has impacted timeliness, accuracy, availability, integrity, consistency and uniqueness of health data. Assessing the current gaps between electronic health record utilisation in relation to enhancing data quality can help to identify and recommend key measures to improve healthcare delivery. This review examines the impact of electronic health record on data quality, and proposes recommendations desirable to improving healthcare delivery. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Integrative Review Frameworks (IRF) were adapted as a sign post for the study. These frameworks guided literature search, data analysis and presentation of findings. Boolean AND/OR operators were combined with search terms to increase relevant search results. Six (6) electronic databases that were used for literature search are Scopus, Web of Science, Science Direct, PubMed, ProQuest and Google Scholar. Searched articles were between 2012 to 2022, with the exception of two articles on the Technology Acceptance Model (TAM) published in 1986 and 1975. EHR implementation impact key health outcomes and contribute to timely and complete data submission. Implementation of Electronic Health Systems (EHS) embellish consistency, completeness, accuracy and integrity of clinical data significantly through embedded interoperability solutions. By reducing the scope of manual reviews, integrating a technology that automates data integrity and quality checks into EHR may potentially lessen the strain of maintaining data quality. Our findings depict that interoperability of clinical data sources will ensure consistent, timely and available health data when using EHR. The automated data integrity and consistency checks in the EHR improve data quality. The study contributes to advancing the theory of Technology Acceptance Model (TAM) in electronic health records and its impact on data quality in healthcare delivery.

Effect of electronic health records on doctor-patient relationship in Arabian gulf countries: a systematic review.

The electronic health record (EHR) has been widely implemented internationally as a tool to improve health and healthcare delivery. However, EHR implementation has been comparatively slow amongst hospitals in the Arabian Gulf countries. This gradual uptake may be linked to prevailing opinions amongst medical practitioners. Until now, no systematic review has been conducted to identify the impact of EHRs on doctor-patient relationships and attitudes in the Arabian Gulf countries. To understand the impact of EHR use on patient-doctor relationships and communication in the Arabian Gulf countries. A systematic review of English language publications was performed using PRISMA chart guidelines between 1990 and 2023. Electronic database search (Ovid MEDLINE, Global Health, HMIC, EMRIM, and PsycINFO) and reference searching restricted to the six Arabian Gulf countries only. MeSH terms and keywords related to electronic health records, doctor-patient communication, and relationship were used. Newcastle-Ottawa Scale (NOS) quality assessment was performed. 18 studies fulfilled the criteria to be included in the systematic review. They were published between 1992 and 2023. Overall, a positive impact of EHR uptake was reported within the Gulf countries studied. This included improvement in the quality and performance of physicians, as well as improved accuracy in monitoring patient health. On the other hand, a notable negative impact was a general perception of physician attention shifted away from the patients themselves and towards data entry tasks (e.g., details of the patients and their education at the time of the consultation). The implementation of EHR systems is beneficial for effective care delivery by doctors in Gulf countries despite some patients' perception of decreased attention. The use of EHR assists doctors with recording patient details, including medication and treatment procedures, as well as their outcomes. Based on this study, the authors conclude that widespread EHR implementation is highly recommended, yet specific training should be provided, and the subsequent effect on adoption rates by all users must be evaluated (particularly physicians). The COVID-19 Pandemic showed the great value of EHR in accessing information and consulting patients remotely.

The Impact of Longitudinal Data-Completeness of Electronic Health Record Data on the Prediction Performance of Clinical Risk Scores.

The impact of electronic health record (EHR) discontinuity (i.e., receiving care outside of a given EHR system) on EHR-based risk prediction is unknown. We aimed to assess the impact of EHR-continuity on the performance of clinical risk scores. The study cohort consisted of patients aged ≥ 65 years with ≥ 1 EHR encounter in the 2 networks in Massachusetts (MA; 2007/1/1-2017/12/31, internal training and validation dataset), and one network in North Carolina (NC; 2007/1/1-2016/12/31, external validation dataset) that were linked with Medicare claims data. Risk scores were calculated using EHR data alone vs. linked EHR-claims data (not subject to misclassification due to EHR-discontinuity): (i) combined comorbidity score (CCS), (ii) claim-based frailty score (CFI), (iii) CHAD2 DS2 -VASc, and (iv) Hypertension, Abnormal renal/liver function, Stroke, Bleeding, Labile, Elderly, and Drugs (HAS-BLED). We assessed the performance of CCS and CFI predicting death, CHAD2 DS2 -VASc predicting ischemic stroke, and HAS-BLED predicting bleeding by area under receiver operating characteristic curve (AUROC), stratified by quartiles of predicted EHR-continuity (Q1-4). There were 319,740 patients in the MA systems and 125,380 in the NC system. In the external validation dataset, AUROC for EHR-based CCS predicting 1-year risk of death was 0.583 in Q1 (lowest) EHR-continuity group, which increased to 0.739 in Q4 (highest) EHR-continuity group. The corresponding improvement in AUROC was 0.539 to 0.647 for CFI, 0.556 to 0.637 for CHAD2 DS2 -VASc, and 0.517 to 0.556 for HAS-BLED. The AUROC in Q4 EHR-continuity group based on EHR alone approximates that based on EHR-claims data. The prediction performance of four clinical risk scores was substantially worse in patients with lower vs. high EHR-continuity.

The impact of electronic health records on healthcare delivery and patient outcomes: A review

This review examines the impact of Electronic Health Records (EHRs) on healthcare delivery and patient outcomes, highlighting the benefits and challenges associated with their use. EHRs enhance healthcare efficiency, improve the quality of care through clinical decision support, and foster better collaboration among healthcare providers. They also contribute to patient safety, engagement, and improved health outcomes, including reduced hospital readmission rates and better chronic disease management. However, data privacy concerns, interoperability issues, and the digital divide pose significant hurdles. The review underscores the critical role of ongoing research and innovation in health informatics to address these challenges, ensuring EHRs continue to evolve positively. This analysis aims to provide a comprehensive overview of the current state of EHRs, offering insights into their potential to transform healthcare delivery and outcomes.

Scoping review: Positive and negative impact of technology on clinicians

BackgroundUnnecessary electronic health record (EHRs) documentation burden and usability issues have negatively impacted clinician well-being (e.g., burnout and moral distress). PurposeThis scoping review was conducted by members from three expert panels of the American Academy of Nurses to generate consensus on the evidence of both positive and negative impact of EHRs on clinicians. MethodsThe scoping review was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Extension for Scoping Reviews guidelines. ResultsThe scoping review captured 1,886 publications screened against title and abstract 1,431 excluded, examined 448 in a full-text review, excluded 347 with 101 studies informing the final review. DiscussionFindings suggest few studies that have explored the positive impact of EHRs and more studies that have explored the clinician's satisfaction and work burden. Significant gaps were identified in associating distress to use of EHRs and minimal studies on EHRs’ impact on nurses. ConclusionExamined the evidence of HIT's positive and negative impacts on clinician's practice, clinicians work environment, and if psychological impact differed among clinicians.

The impact of electronic health record discontinuity on prediction modeling.

To determine the impact of electronic health record (EHR)-discontinuity on the performance of prediction models. The study population consisted of patients with a history of cardiovascular (CV) comorbidities identified using US Medicare claims data from 2007 to 2017, linked to EHR from two networks (used as model training and validation set, respectively). We built models predicting one-year risk of mortality, major CV events, and major bleeding events, stratified by high vs. low algorithm-predicted EHR-continuity. The best-performing models for each outcome were chosen among 5 commonly used machine-learning models. We compared model performance by Area under the ROC curve (AUROC) and Area under the precision-recall curve (AUPRC). Based on 180,950 in the training and 103,061 in the validation set, we found EHR captured only 21.0-28.1% of all the non-fatal outcomes in the low EHR-continuity cohort but 55.4-66.1% of that in the high EHR-continuity cohort. In the validation set, the best-performing model developed among high EHR-continuity patients had consistently higher AUROC than that based on low-continuity patients: AUROC was 0.849 vs. 0.743 when predicting mortality; AUROC was 0.802 vs. 0.659 predicting the CV events; AUROC was 0.635 vs. 0.567 predicting major bleeding. We observed a similar pattern when using AUPRC as the outcome metric. Among patients with CV comorbidities, when predicting mortality, major CV events, and bleeding outcomes, the prediction models developed in datasets with low EHR-continuity consistently had worse performance compared to models developed with high EHR-continuity.

An integrative review exploring the impact of Electronic Health Records (EHR) on the quality of nurse-patient interactions and communication.

To explore how nurses' use of electronic health records impacts on the quality of nurse-patient interactions and communication. An integrative review. MEDLINE®, CINAHL®, PscyINFO, PubMed, BNI and Cochrane Library databases were searched for papers published between January 2005 and April 2022. Following a comprehensive search, the studies were appraised using a tool appropriate to the study design. Data were extracted from the studies that met the inclusion criteria relating to sample characteristics, methods and the strength of evidence. Included empirical studies had to examine interactions or communication between a nurse and patient while electronic health records were being used in any healthcare setting. Findings were synthesized using a thematic approach. One thousand nine hundred and twenty articles were initially identified but only eight met the inclusion criteria of this review. Thematic analysis revealed four key themes, indicating that EHR: impedes on face-to-face communication, promotes task-orientated and formulaic communication and impacts on types of communication patterns. Research examining nurse-patient interactions and communication when nurses' use electronic health records is limited but evidence suggests that closed nurse-patient communications, reflecting a task-driven approach, were predominantly used when nurses used electronic health records, although some nurses were able to overcome logistical barriers and communicate more openly. Nurses' use of electronic health records impacts on the flow, nature and quality of communication between a nurse and patient. The move to electronic health records has taken place largely without consideration of the impact that this might have on nurse-patient interaction and communication. There is evidence of impact but also evidence of how this might be mitigated. Nurses must focus future research on examining the impact that these systems have, and to develop strategies and practice that continue to promote the importance of nurse-patient interactions and communication. Studies examined within this review included patient participants that informed the analysis and interpretation of data.

The Impact of Meaningful Use and Electronic Health Records on Hospital Patient Safety.

The HITECH Act aimed to leverage Electronic Health Records (EHRs) to improve efficiency, quality, and patient safety. Patient safety and EHR use have been understudied, making it difficult to determine if EHRs improve patient safety. The objective of this study was to determine the impact of EHRs and attesting to Meaningful Use (MU) on Patient Safety Indicators (PSIs). A multivariate regression analysis was performed using a generalized linear model method to examine the impact of EHR use on PSIs. Fully implemented EHRs not attesting to MU had a positive impact on three PSIs, and hospitals that attested to MU had a positive impact on two. Attesting to MU or having a fully implemented EHR were not drivers of PSI-90 composite score, suggesting that hospitals may not see significant differences in patient safety with the use of EHR systems as hospitals move towards pay-for-performance models. Policy and practice may want to focus on defining metrics and PSIs that are highly preventable to avoid penalizing hospitals through reimbursement, and work toward adopting advanced analytics to better leverage EHR data. These findings will assist hospital leaders to find strategies to better leverage EHRs, rather than relying on achieving benchmarks of MU objectives.

Clinician Perceptions of Transition From Legacy Electronic Health Record to MHS GENESIS: A Pilot Study.

The implementation of a new electronic health record (EHR) presents significant challenges as users navigate a new interface. Our institution was an early adopter of MHS GENESIS (MHSG), the MHS's new EHR. This study investigated provider perceptions of usability and the prevalence of burnout during an EHR transition from the Legacy system (LEHR) utilizing online, anonymous surveys before implementation and at several points post-implementation. Clinician satisfaction, perceptions of EHR impact on safety, communication, reliability, and chart completion were assessed on five-point Likert scales. Usability was assessed using the validated System Usability Scale (SUS). Burnout prevalence was assessed using a validated single-item measure. Data were gathered via online, anonymous surveys before implementation and at 1, 3-6, and 9-12 months post "Go-Live." Of 367 clinicians, 56 responded to the baseline survey; on average, 29% of responses were positive (i.e., satisfied or very satisfied) with LEHR. Following implementation, an average of 47%, 37%, and 47% of responses were positive for MHSG at 1 months (n = 42), 6 months (n = 55), and 12 months (n = 30), respectively. The mean SUS for LEHR was 48 (on a scale of 1-100); for MHSG, the mean SUS was 48 (1 month), 41 (6 months), and 44 (12 months). The burnout rate was reported as 39% (baseline), 26% (1 month), 33% (6 months), and 37% (12 months). Perceptions of system usability, physician satisfaction, and burnout were not remarkably different between the two systems. Study results imply a need for further investigation as to why most clinicians continue to be unsatisfied with MHSG and wish to return to LEHR and whether or how this EHR transition contributed to burnout or if other factors are more contributory in this population. Future studies could also explore whether changes in the clinician interface, training, or implementation process impact clinician satisfaction, burnout, and desire to return to LEHR, or if these measures change with longer follow-up or in more varied populations.

Through the Narrative Looking Glass: Commentary on "Impact of Electronic Health Records on Information Practices in Mental Health Contexts: Scoping Review".

The authors of “Impact of Electronic Health Records on Information Practices in Mental Health Contexts: Scoping Review” have effectively brought to our attention the failure of the electronic health record (EHR) to represent the human context. Because mental health or behavioral disorders (and functional status in general) emerge from an interaction between the individual’s characteristics and the social context, it is essentially a failure to represent the human context. The assessment and treatment of these disorders must reflect how the person lives, their degree of social connectedness, their personal motivation, and their cultural background. This type of information is best communicated both through narrative and in collaboration with other providers and the patient—largely because human social memory is organized around situation models and natural episodes. Neither functionality is currently available in most EHRs. Narrative communication is effective for several reasons: (1) it supports the communication of goals between providers; (2) it allows the author to express their belief in others’ perspectives (theory of mind), for example, those who will be reading these notes; and (3) it supports the incorporation of the patient’s personal perspective. The failure of the EHR to support mental health information data and information practices is, therefore, essentially a failure to support the basic communication functions necessary for the narrative. The authors have rightly noted the problems of the EHR in this domain, but perhaps they did not completely link the problems to the lack of functionality to support narrative communication. Suggestions for adding design elements are discussed.

Impact of Electronic Health Records on Information Practices in Mental Health Contexts: Scoping Review.

BackgroundThe adoption of electronic health records (EHRs) and electronic medical records (EMRs) has been slow in the mental health context, partly because of concerns regarding the collection of sensitive information, the standardization of mental health data, and the risk of negatively affecting therapeutic relationships. However, EHRs and EMRs are increasingly viewed as critical to improving information practices such as the documentation, use, and sharing of information and, more broadly, the quality of care provided.ObjectiveThis paper aims to undertake a scoping review to explore the impact of EHRs on information practices in mental health contexts and also explore how sensitive information, data standardization, and therapeutic relationships are managed when using EHRs in mental health contexts.MethodsWe considered a scoping review to be the most appropriate method for this review because of the relatively recent uptake of EHRs in mental health contexts. A comprehensive search of electronic databases was conducted with no date restrictions for articles that described the use of EHRs, EMRs, or associated systems in the mental health context. One of the authors reviewed all full texts, with 2 other authors each screening half of the full-text articles. The fourth author mediated the disagreements. Data regarding study characteristics were charted. A narrative and thematic synthesis approach was taken to analyze the included studies’ results and address the research questions.ResultsThe final review included 40 articles. The included studies were highly heterogeneous with a variety of study designs, objectives, and settings. Several themes and subthemes were identified that explored the impact of EHRs on information practices in the mental health context. EHRs improved the amount of information documented compared with paper. However, mental health–related information was regularly missing from EHRs, especially sensitive information. EHRs introduced more standardized and formalized documentation practices that raised issues because of the focus on narrative information in the mental health context. EHRs were found to disrupt information workflows in the mental health context, especially when they did not include appropriate templates or care plans. Usability issues also contributed to workflow concerns. Managing the documentation of sensitive information in EHRs was problematic; clinicians sometimes watered down sensitive information or chose to keep it in separate records. Concerningly, the included studies rarely involved service user perspectives. Furthermore, many studies provided limited information on the functionality or technical specifications of the EHR being used.ConclusionsWe identified several areas in which work is needed to ensure that EHRs benefit clinicians and service users in the mental health context. As EHRs are increasingly considered critical for modern health systems, health care decision-makers should consider how EHRs can better reflect the complexity and sensitivity of information practices and workflows in the mental health context.

The Impact of Electronic Health Records on Patient Care in the US Healthcare System

Patient care has undergone a substantial transformation as a result of the US healthcare system’s implementation of Electronic Health Records (EHRs). This study explores the complex effects of EHRs on several facets of patient outcomes and healthcare delivery.

A Qualitative Analysis of the Impact of Electronic Health Records (EHR) on Healthcare Quality and Safety: Clinicians' Lived Experiences.

Purpose:There have been mixed findings of clinicians’ perceptions of Electronic Health Record (EHR). This study aims to explore the lived experiences of clinicians, to assess the role of EHR in improving the quality and safety of healthcare.Basic Procedures:A qualitative study design was used. We collected the opinions from different groups of clinicians (physicians, hospitalists, nurse practitioners, nurses, and patient safety officers) using semi-structured interviews. Organizations represented were trauma hospitals, academic medical centers, medical clinics, home health centers, and small hospitals.Main findings:Our study found clinicians’ ambivalent assessments toward EHR, which confirms extant literature. We compared the responses by job roles and found that nurses were positive about improving efficiency with EHR while others regarded EHR as time-consuming. While many underscored the importance of EHR in avoiding medical errors by improving data accessibility, nurses had concerns regarding data accuracy. Interoperability appeared to be a concern given limited system integration.Principal conclusions:Lived experiences of clinicians further tease out the mixed views about the effectiveness of EHR and highlight the challenges in EHR implementation. Redesigning the EHR and improving its implementation process may be potential solutions to increase its effectiveness.