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Journal of the American Medical Informatics Association: JAMIA logoLink to Journal of the American Medical Informatics Association: JAMIA
. 2024 Sep 3;31(11):2740–2748. doi: 10.1093/jamia/ocae228

Implementation and delivery of electronic health records training programs for nurses working in inpatient settings: a scoping review

Oliver T Nguyen 1,2, Steven D Vo 3, Taeheon Lee 4, Kenrick D Cato 5,6, Hwayoung Cho 7,✉
PMCID: PMC11491623  PMID: 39225789

Abstract

Objectives

Well-designed electronic health records (EHRs) training programs for clinical practice are known to be valuable. Training programs should be role-specific and there is a need to identify key implementation factors of EHR training programs for nurses. This scoping review (1) characterizes the EHR training programs used and (2) identifies their implementation facilitators and barriers.

Materials and Methods

We searched MEDLINE, CINAHL, PsycINFO, and Web of Science on September 3, 2023, for peer-reviewed articles that described EHR training program implementation or delivery to nurses in inpatient settings without any date restrictions. We mapped implementation factors to the Consolidated Framework for Implementation Research. Additional themes were inductively identified by reviewing these findings.

Results

This review included 30 articles. Healthcare systems’ approaches to implementing and delivering EHR training programs were highly varied. For implementation factors, we observed themes in innovation (eg, ability to practice EHR skills after training is over, personalizing training, training pace), inner setting (eg, availability of computers, clear documentation requirements and expectations), individual (eg, computer literacy, learning preferences), and implementation process (eg, trainers and support staff hold nursing backgrounds, establishing process for dissemination of EHR updates). No themes in the outer setting were observed.

Discussion

We found that multilevel factors can influence the implementation and delivery of EHR training programs for inpatient nurses. Several areas for future research were identified, such as evaluating nurse preceptorship models and developing training programs for ongoing EHR training (eg, in response to new EHR workflows or features).

Conclusions

This scoping review highlighted numerous factors pertaining to training interventions, healthcare systems, and implementation approaches. Meanwhile, it is unclear how external factors outside of a healthcare system influence EHR training programs. Additional studies are needed that focus on EHR retraining programs, comparing outcomes of different training models, and how to effectively disseminate updates with the EHR to nurses.

Keywords: nurses, electronic health records, computer user training, implementation

Introduction

Healthcare systems have adopted electronic health records (EHRs) systems to facilitate healthcare delivery and the potential benefits of EHRs have been well-documented in the literature.1–3 As the adoption rate of EHRs is reportedly high in some countries,4–8 healthcare system leaders are transitioning to optimizing the use of EHRs to best support clinicians’ decision-making. There are several consequences of suboptimal EHR design and inefficient EHR use, including patient safety concerns,9–12 increased cognitive burden among clinicians,13,14 and increased time spent in the EHR.15 Higher EHR use and poor perceptions of EHR performance may lead to several adverse outcomes, such as perceived burnout,9,16–18 intentions of leaving the healthcare organization,9,19 and turnover.20 In light of these adverse outcomes, healthcare systems are implementing interventions to improve EHR use. EHR training programs represent one particular intervention that has been increasingly explored to improve the overall use of EHRs.21–25

Training programs are a key component of implementation strategies in several implementation science frameworks,26–28 including among studies describing and assessing EHR implementation.29–31 Evaluations of training-related outcomes after undergoing EHR training programs designed for clinical practice have also been favorable.21–24,32–36 There is also emerging evidence that EHR training programs may lead to reduced burnout.22,24 These promising results support the need to understand how to design and implement EHR training programs. Notably, since EHR workflows and modules may differ based on the role of the healthcare worker, the content included in the EHR user training program may need to be tailored based on the learner’s role type (eg, nurse vs clerical staff). Globally, in 2020, there were approximately 29.1 million nurses and they accounted for the most prevalent type of healthcare worker.37 This suggests that nurses also represent a considerable number of EHR end-users in a healthcare system. Consequently, it is worthwhile to examine current approaches to EHR training programs that have been developed and implemented specifically for nurses.

Despite the value of EHR training programs, not all healthcare systems provide these to their nurses.38–42 Furthermore, completing EHR training programs may not always translate to improved perceived self-efficacy and optimal EHR use patterns among healthcare workers. For instance, researchers have highlighted how a considerable number of nurses perceived their EHR training programs did not prepare them well for the EHR workflows they needed to use as part of daily nursing care.13,38,40,41,43,44 Nurses also may have unique constraints that may affect the design and implementation decisions of EHR training programs. For instance, traveling and floater nurses rotate through different floors and specialties, creating challenges for orienting these nurses to floor-specific EHR workflows. Consequently, it is important to identify facilitators contributing to the design and implementation of effective EHR training programs and barriers that potentially inhibit the delivery of EHR training programs. Although reviews have been published to summarize the impact of EHR training programs and their training content,32,45 to our knowledge, there is no review to date that examines the facilitators and barriers on implementing and delivering EHR training programs to nurses working in inpatient settings and how they may influence the effectiveness of the EHR training program.

To address this gap, this scoping review’s objective was to characterize the available literature’s implementation and delivery of EHR training programs to nurses in the inpatient setting. We also summarized implementation facilitators and barriers for EHR training programs to nurses from studies that offered information on whether the EHR training program was effective. These findings may benefit healthcare system and informatics leaders who are designing or optimizing training efforts to improve EHR users’ proficiency.

Methods

This scoping review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) extension for scoping reviews (PRISMA-ScR) checklist.46 A completed reporting checklist is available in File S1. This protocol was not previously registered in any repository. This study used publicly available data and was exempt from institutional review board approval at the University of Florida.

Data sources and search

We developed a search strategy with a medical sciences librarian that included search terms and headings for nurses, EHRs, and training program delivery (File S2). Our inclusion criteria were: (1) details on EHR training programs were described, (2) training programs were targeting EHR skills and behaviors as opposed to other competencies (eg, clinical decision-making, delivering clinical trial interventions), (3) training programs were delivered to nurses working in inpatient settings, (4) articles were peer-reviewed, and (5) articles were written in English. Since EHR training programs may be influenced by clinician roles, we excluded articles that targeted nurse practitioners (eg, their training programs may also include how to place and sign orders) and student nurses. We also did not include gray literature since conference abstracts are unlikely to provide enough details on EHR training programs and we did not expect to find any white reports that focused on EHR training programs. On September 5, 2023, we ran the search strategy in MEDLINE (PubMed), Web of Science, PsycINFO, and CINAHL without any date restrictions. We also hand-searched the bibliographies of included articles for other relevant studies to review.

Study selection

Three members of our study team (O.T.N., S.D.V., and T.L.) participated in the title and abstract screening as well as the full-text screening processes. Each article’s title and abstract were independently screened by a pair of reviewers. Similarly, for full-text reviews, a pair of reviewers independently assessed each article for final eligibility. Conflicts were reconciled by a third reviewer (H.C.). All review decisions were recorded using Covidence, a web-based application that facilitates review workflows.47 Inter-rater reliability was assessed.

Data extraction, synthesis, and analysis

Three members of the study team (O.T.N., S.D.V., and T.L.) participated in the data abstraction process. For each included study, a pair of reviewers abstracted the following information: (1) location (country), (2) study design, (3) unit of inpatient care, (4) hospital characteristics, (5) main training context (eg, onboarding vs implementation), (6) content areas of training, (7) entity that developed the training program, (8) entity that delivered the training program, (9) length of time period spent on training a nurse, (10) training modalities used (eg, classroom training, online modules), (11) whether the study reported effectiveness results of the EHR training program, and (12) facilitators and barriers of training program implementation and/or delivery. To help identify patterns in commonly encountered facilitators and barriers, we mapped these identified factors from the included studies to the updated Consolidated Framework for Implementation Research (CFIR).48 The CFIR provides an extensive list on the types of facilitators and barriers that can influence implementation of interventions. This framework also suggests that multilevel factors contribute to the success of an implementation. The levels include: (1) the innovation being implemented, (2) the outer setting that encompasses the social, economic, and political factors that affect the immediate work setting studied, (3) the inner setting that characterizes the immediate work setting studied, (4) individuals affected, and (5) aspects of the implementation process.48 We inductively created additional sub-themes for each of the domains based on the consensus of the study team. Discrepancies in the mapping process were resolved by a third reviewer (H.C.).

Results

Study characteristics

Our search strategy resulted in 3765 de-duplicated articles for review. After title and abstract screening, 63 articles remained for full-text review. We ultimately included 30 studies in this review (Figure 1).30,38,43,44,49–74 The authors had high agreement when making review decisions (Cohen’s k = 0.84). Studies used either a cohort design (n = 16, 53.3%) or a descriptive design (n = 14, 46.7%). Most studies (n = 20, 66.7%) were conducted in the United States. Other countries represented include Canada (n = 2, 6.7%), Australia (n = 1, 3.3%), and those in Asia (n = 4, 13.3%) and Africa (n = 2, 6.7%). Hospital characteristics were varied in size (ie, number of beds), teaching status, and rurality. Although most studies (56.7%) did not further specify what type of inpatient service was targeted in their studies, the remaining studies’ settings included intensive care units as well as psychiatry, medical, oncology, labor and delivery, and surgical units (File S3).

Figure 1.

Flowchart depicting how many articles were reviewed, excluded with reasons why, and how many articles were ultimately included in the analysis.

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PRISMA flowchart illustrating the study selection process.

Seventeen studies (56.7%) reported on implementation-related factors of EHR training programs (Table 1). Overall, we identified factors from the included studies that were associated with innovation, inner setting (ie, internal to the hospital), individuals, and implementation process. No factors were found pertaining to the outer setting (ie, external to the hospital).

Table 1.

Implementation factors of EHR training programs to nurses.

Domain Theme Type of implementation factor Identified factor Study
Innovation Ability to practice EHR skills after training is over Facilitator Letting nurses practice in EHR after training Chao and Goldbort, 2012
Facilitator Training room open for practice Jung et al., 2021
Barrier Not being able to practice in sandbox Smailes, 2020
Personalizing training Facilitator Offering one-on-one support sessions to individuals who need further training Shala et al., 2021
Barrier Using role-based training rather than delivering training based on skill level of learner Colligan et al., 2015
Barrier Not being able to test out of content if nurse had EHR experience already Smailes et al., 2019
Barrier Not being able to test out of content Smailes, 2020
Barrier Not splitting up training sessions by role type Stromberg, 2011
Engaging learners Facilitator Training was done in a concise and interactive format Topaz et al., 2013
Barrier Lack of visual cues to assess if employees are struggling Brown et al., 2022
Barrier Unable to physically point out information on screen Brown et al., 2022
Barrier Students being unable to ask questions if muted Brown et al., 2022
Training pace Facilitator Breaking up training into several days Stromberg, 2011
Barrier Placing too much training content in a short period of time Stromberg, 2011
Barrier Loss of attention from consecutive training length Stromberg, 2011
Barrier Too much training content in a short period of time Whittaker et al., 2009
Barrier Perceived fragmentation of training Schenk et al., 2016
Facilitator Self-paced speed Smailes, 2020
Accessible training platform Facilitator Web deployment of training Keenan et al., 2012
Training covers EHR workflows Barrier Training was focused on how to use the computer rather than how to integrate the EHR into nursing practice Furlong, 2016
Avoiding continuous use of examples that learners cannot relate to Barrier Trainer using centric verbiage, such as “on my unit” or “at my hospital” Malane et al., 2019
Inner Setting Training budget Barrier Costs of hiring trainers Kumar et al., 2013
Barrier Limited budget Kumar et al., 2013
Availability of computers for training Facilitator Conference room with computers available Sockolow et al., 2014
Barrier Limited number of computers Harton et al., 2009
Barrier Not enough space in computer labs to train Kumar et al., 2013
Server uptime Barrier Overloaded Skype server that led to connection issues Brown et al., 2022
Barrier Downtime of the online training system Shala et al., 2021
Stakeholder involvement Facilitator Collaborating with nurse educators, hospital leaders, and unit leaders Topaz et al., 2013
Facilitator Having a nursing professional development group involved Malane et al., 2019
Accessibility of training Barrier Different work shifts Kumar et al., 2013
Clear documentation requirements and expectations Barrier Lack of documentation standards Sockolow et al., 2014
Individuals Computer literacy Barrier Nurses’ lack of experience with computers Harton et al., 2009
Learning preferences Barrier Personal preferences for instructor-led formats Smailes et al., 2019
Trust in trainers Barrier Interpersonal issues with proctor Smailes et al., 2019
Implementation Process Trainers and support staff hold nursing backgrounds Facilitator Super-users Sockolow et al., 2014
Facilitator Early adopters served as educational champions Topaz et al., 2013
Facilitator Super-users Whittaker et al., 2009
Reminders to complete training Facilitator Emails sent twice Topaz et al., 2013
Facilitator Printed emails at nursing stations Topaz et al., 2013
Motivation to complete training Facilitator Required training to be done Topaz et al., 2013
Barrier Not everyone completed training Sockolow et al., 2014
Barrier Lack of incentives to complete training Topaz et al., 2013
Dissemination of EHR updates Facilitator EHR updates had to be done through a familiar format and through established channels Topaz et al., 2013
Barrier No process to distribute important educational updates post-training that affect EHR documentation Malane et al., 2019
Barrier Changes to the system were not communicated Sockolow et al., 2014
Time allotted to complete training Barrier Limited time to train Kumar et al., 2013
Barrier Not enough time to complete modules Smailes et al., 2019
Barrier Lack of dedicated time to complete training Topaz et al., 2013
Conducting training close to date of implementation Barrier Long time between training and EHR implementation Chao and Goldbort, 2012
Barrier Training dates were much earlier than implementation Whittaker et al., 2009
Avoiding the need to be proficient in 2 EHRs at once Barrier The old EHR system was still being used Malane et al., 2019
Barrier Required EHR ambassadors to be educated to new system while still teaching the old one Malane et al., 2019
Trainers inventory and adjust to learners’ needs Facilitator Trainers adapted to training needs Jung et al., 2021
Offering training at multiple times Facilitator Training sessions held throughout study Keenan et al., 2012
Having training in area free of distractions and interruptions Barrier Having training on patient floors Chao and Goldbort, 2012
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Abbreviation: EHR = electronic health record.

EHR training program characteristics

Overall, training programs generally supported onboarding processes or the implementation of an EHR system or a new feature within an existing EHR system. Most studies (n = 17, 56.7%) did not provide details on training content. Of the remaining studies that did, training content was highly varied and generally focused on EHR workflows. Some studies also focused on the familiarization of specific EHR features, such as templates, electronic medication administration systems, care plans, and calculators.

Across the 14 studies that reported who developed the training program, all but one indicated that the EHR training program was internally developed within the academic medical center by nursing faculty, internal information technology education teams, or nursing informaticians; or clinical nurse specialists. Similar to the development of training programs, most studies reported that training programs were delivered by someone in the academic medical center as opposed to the EHR vendor. These types of individuals included the same types of individuals who developed the training programs as well as charge nurses and staff nurses.

Training program length ranged from a few hours in the same day to several days or weeks. Longer periods were chosen to allow nurses time to process the information and practice taught skills. Some EHR training programs were delivered synchronously to nurses in the form of classroom training or virtual lectures delivered in real-time. Other programs used asynchronous methods, including emailed information and online modules. The use of simulations and sandbox EHR environments were also identified as a core component of several studies’ training approaches (File S2).

Facilitators and barriers to EHR training program implementation and delivery

Fifteen studies identified 7 innovation factors that may be related to the effectiveness of their EHR training program implementation and delivery.30,43,51,53,54,59,61,64,65,67,68,71–74 These included the ability to practice EHR skills after training was over, personalizing training, engaging learners, training pace, accessible training platforms, training covering EHR workflows, and avoiding continuous use of examples that learners cannot relate to.

Seven studies revealed 6 factors of the inner setting that may contribute to EHR training programs’ effectiveness.51,57,60,61,65,69,72 These included training budgets, availability of computers for training purposes, server uptime, stakeholder involvement, accessibility of training, and clear documentation requirements and expectations.

Two studies highlighted 3 individual-level factors that may contribute to EHR training programs’ effectiveness.57,67 These included computer literacy, learning preferences, and trust in trainers.

Ten studies reported on implementation-related factors that may contribute to EHR training programs’ effectiveness.30,53,59–61,67,69,72–74 These included trainers and support staff holding nursing backgrounds, super-users (ie, nurses who were highly proficient with the EHR), reminders to complete training, incentives and mandates to complete training, dissemination of EHR updates, time allotted to complete training, conducting training close to the date of implementation, avoiding the need to be proficient in 2 EHRs at once, trainers assessing and adjusting to learners’ needs, offering training at multiple times, and having training in areas free of distractions and interruptions (Table 1).

Discussion

Primary findings

This scoping review summarized the characteristics, facilitators, and barriers of EHR training program implementation and delivery for nurses working in inpatient settings. Overall, EHR training approaches used by healthcare systems varied in several characteristics, such as training contexts, who developed the training program, who delivered the training program, and types of modalities used. The studies also identified numerous categories of facilitators and barriers of implementing and delivering EHR training programs for nurses, including factors associated with innovations, inner setting, individuals, and implementation process, which highlight the importance of considering multilevel factors when implementing and delivering EHR training programs to nurses. Our review did not restrict included studies by publication year. Although some factors, such as having a limited number of computers for training or low computer literacy skills among nurses, may be less of an issue for contemporary EHR training programs, most factors continue to be relevant for health systems in current times. We discuss the implications for clinical practice and research below.

Implications of identified innovation factors

We noted numerous innovation-related factors in our review that emphasize different learning curves and needs among nurses. For instance, some healthcare systems allowed nurses to practice their EHR skills and workflows in a dedicated computer lab or a sandbox (ie, testing environment). Others supplemented class training with one-on-one training. These findings underscore the importance of recognizing varied levels of comfort and proficiency that nurses have with the EHR. Consequently, designing an EHR training curriculum that simultaneously meets the training needs and expectations of nurses with low, moderate, and high baseline EHR proficiency levels may be infeasible. In response to this, some studies in this review attempted to address this by providing supplemental training for nurses who were struggling or had created mechanisms for experienced nurses to “test out” of content if they can demonstrate that they already know the content or have received the EHR training elsewhere.67,68 These represent promising aspects for healthcare systems to adopt. Notably, healthcare systems with asynchronous online training also were able to offer nurses the ability to complete training at a pace they were comfortable with. However, these training models may be more suitable for onboarding nurses than for providing re-training or disseminating new workflows associated with upgrades in the EHR. In the latter cases, nurses often do not have dedicated time to complete training when they are working on patient floors. Consequently, the differential value of asynchronous training in these cases may be limited. Additional research is needed on effective ways to structure training content for working nurses. There also remains questions on how different EHR training models (eg, in-person only vs online only vs hybrid) compare among one another in terms of downstream EHR proficiency and efficiency.

Implications of implementation process factors

Several aspects of implementation are also worth highlighting. First, several studies in our review suggest that the use of trainers or super-users who are both proficient with the EHR and have a nursing background can facilitate EHR training programs for nurses.69,72–74 Similar sentiments have also been reported for physician learners.75 This may stem from enhanced abilities to contextualize EHR workflows in broader cognitive processes to support clinical evaluation and decision-making. Second, our review also found that not all nurses were able to complete EHR training programs especially in the contexts of implementation as opposed to onboarding. Some studies in this review also found that requiring training programs to be completed still did not result in full compliance. The reasons for this are unclear. Some possible explanations offered in this review include EHR training programs occurring in a place with distractions and the healthcare system not permitting sufficient time for nurses to complete EHR training programs or to thoroughly review how EHR updates impact their workflows. This suggests that simply enforcing the completion of training programs without providing supportive resources may inhibit training program reach and effectiveness.

Paucity of known outer setting factors

Our review also found a surprising absence of outer setting factors in the literature. This may suggest that outer settings have a minimal role in EHR training program implementation and delivery but this is unlikely. Outer settings include external forces that can influence organizational behavior and implementation strategies of the institution of interest.26,48 Several studies examining external accreditation and policies have demonstrated their roles in influencing internal organizational changes that impact nurses, such as legislation to spur the adoption of EHR systems and achieving Magnet status can improve organizational culture and adoption of practices to minimize patient safety issues.76,77 Furthermore, nursing school programs that provide didactic and/or experiential learning opportunities involving the EHR have been suggested to affect nurses’ EHR skills.78 Put together, there is a need for additional research to examine how accreditation criteria, insurance and government policies, and nursing school preparation can influence EHR training program design and implementation in hospital settings.

Paucity of EHR re-training programs and EHR updates

Another important finding was the included articles’ general focus of EHR training programs on supporting the initial implementation of a brand-new EHR. Meanwhile, fewer studies have been published that describe approaches to delivering periodic EHR retraining. We know that EHRs are dynamic, evolving over time, as new features are developed and integrated into the existing system or when interfaces and workflows are redesigned.79,80 Consequently, the training content used to support initial EHR implementation should differ from the training content used to sustain EHR use as time goes on.

The literature also predominantly focused on EHR training programs in the context of onboarding new nurses to the healthcare system. Although this suggests that nurses complete formalized EHR training programs only once, other studies in the literature have shown the beneficial outcomes of offering periodic or supplemental EHR retraining sessions to clinicians. These benefits include improved EHR proficiency and perceived EHR self-efficacy.23,24 Notably, these studies generally targeted physicians, physician assistants, and nurse practitioners.23,24 Given the potential value of EHR retraining, similar approaches should be explored in future research within the constraints specific to nurses working in inpatient settings. For instance, although most types of clinicians can receive this training during times when they are not scheduled to see patients, nurses generally have direct patient care contact during most or all of their shifts.

Limitations

This review comes with several limitations. First, most studies examined training program delivery for staff nurses, which may not generalize to other types of nurses (eg, travel nurses, floaters) in inpatient settings. Furthermore, most studies were conducted in non-rural and non-safety net hospitals. However, rural and safety net hospitals may have relatively fewer resources to devote to training program efforts.81 Consequently, they may require different approaches to implementing and delivering EHR training programs to their nurses. This represents an area in need of further research. Second, similar to other reviews, our review was limited by relatively sparse details from several studies on training program implementation and delivery. This points toward a need for more consistent reporting of training program characteristics to enable other healthcare systems to identify key components of effective training programs that they need to integrate into their own approaches. Third, as discussed previously, this review found a paucity of studies describing and evaluating EHR retraining programs and there will be a growing need for additional research in this area. Fourth, no study in this review examined how nurse preceptorships support EHR training.82 Since these training models rely on nurse preceptors imparting their personal EHR knowledge and practices to newer nurses, this can propagate both effective and ineffective EHR practices. Consequently, this represents another area for future inquiry. Notwithstanding these limitations, our review adds to the literature a summary of facilitators and barriers to help guide the delivery of EHR training programs for nurses and identifies several areas for future inquiry. Additional research is needed on how to build up and sustain some of these factors, such as approaches for disseminating news on EHR updates, mechanisms for experienced nurses to test out of training content and balancing the logistical conflicts of dividing training into multiple days or weeks versus reducing onboarding time to get nurses on to the floor quicker.

Conclusions

EHR training programs can help improve EHR proficiency among nurses and healthcare systems’ approaches to implementing and delivering these programs are highly varied. The findings from this scoping review highlighted the numerous factors pertaining to training interventions, healthcare systems, and implementation approaches. Meanwhile, it is less clear how external factors outside of a healthcare system influences EHR training programs. Additional studies are needed that focus on EHR retraining, comparing outcomes of different training models, and how to effectively disseminate updates with the EHR to nurses.

Supplementary Material

ocae228_Supplementary_Data
ocae228_supplementary_data.zip (92.1KB, zip)

Acknowledgments

We wish to thank our health sciences librarian, Margaret Ansell, for her review and feedback on our initial search strategy. We also thank undergraduate students Jakyra McCloud and Lianny Propest for assisting with collecting the data.

Contributor Information

Oliver T Nguyen, Department of Family, Community and Health System Science, College of Nursing, University of Florida, Gainesville, FL 32611, United States; Department of Industrial and Systems Engineering, University of Wisconsin at Madison, Madison, WI 53706, United States.

Steven D Vo, Department of Epidemiology & Biostatistics, University of South Florida, Tampa, FL 33612, United States.

Taeheon Lee, Department of Biotechnology, Ghent University Global Campus, Incheon 21985, South Korea.

Kenrick D Cato, Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, United States; Department of Pediatric Data and Analytics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, United States.

Hwayoung Cho, Department of Family, Community and Health System Science, College of Nursing, University of Florida, Gainesville, FL 32611, United States.

Author contributions

Oliver T. Nguyen and Hwayoung Cho conceptualized the study. Oliver T. Nguyen, Steven D. Vo, and Taeheon Lee collected and analyzed the data. All authors interpreted the data. Oliver T. Nguyen drafted the manuscript. Steven D. Vo, Taeheon Lee, Kenrick D. Cato, and Hwayoung Cho provided critical revisions to the manuscript. All authors approved the submission.

Supplementary material

Supplementary material is available at Journal of the American Medical Informatics Association online.

Funding

This study was supported by the University of Florida College of Nursing Internal Pilot Project Award (to H.C.). The funder had no role in the collection, analysis, or interpretation of the data.

Conflicts of interest

None declared.

Data availability

Studies used in this review are publicly available. All data extracted as part of this review have been presented in this article.

Prior presentations

Portions of this work have been presented as a poster presentation at the 2024 Nursing Research Summit and Malasanos Lectureship.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

ocae228_Supplementary_Data
ocae228_supplementary_data.zip (92.1KB, zip)

Data Availability Statement

Studies used in this review are publicly available. All data extracted as part of this review have been presented in this article.

Articles from Journal of the American Medical Informatics Association : JAMIA are provided here courtesy of Oxford University Press

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