. 2019 Feb 20;10(1):129–139. doi: 10.1055/s-0039-1678551

Table 4. Odds ratios (OR) indicating the effects of a comprehensive electronic health record (EHR) and work environment on nurse assessments of EHR system usability and quality of care ( n = 12,377) .

	Estimated separately	Estimated jointly	Fully adjusted
Outcome	OR (95% CI)	OR (95% CI)	OR (95% CI)
Not satisfied with the system
Comprehensive EHR	0.68 (0.55–0.84) ^a	0.74 (0.61–0.90) ^b	0.75 (0.61–0.92) ^b
Work environment	0.59 (0.51–0.68) ^a	0.61 (0.52–0.70) ^a	0.67 (0.58–0.77) ^a
System does not make it easy to access a patient's clinical data quickly
Comprehensive EHR	0.60 (0.49–0.74) ^a	0.64 (0.53–0.78) ^a	0.65 (0.53–0.79) ^a
Work environment	0.64 (0.55–0.73) ^a	0.66 (0.58–0.76) ^a	0.73 (0.64–0.83) ^a
The systems interfere with the provision of patient care
Comprehensive EHR	0.90 (0.81–1.01)	0.93 (0.84–1.04)	0.97 (0.87–1.08)
Work environment	0.81 (0.74–0.88) ^a	0.81 (0.75–0.88) ^a	0.84 (0.77–0.92) ^a
Systems are not easy to use
Comprehensive EHR	0.71 (0.59–0.84) ^a	0.75 (0.64–0.89) ^a	0.78 (0.66–0.93) ^b
Work environment	0.66 (0.59–0.75) ^a	0.68 (0.60–0.76) ^a	0.76 (0.67–0.86) ^a
I do not trust the accuracy of the patient assessment data documented in the system
Comprehensive EHR	0.83 (0.71–0.98) ^c	0.90 (0.78–1.05)	0.94 (0.81–1.10)
Work environment	0.60 (0.54–0.67) ^a	0.61 (0.54–0.68) ^a	0.64 (0.57–0.72) ^a
I do not trust the accuracy of the medication information in the systems
Comprehensive EHR	0.81 (0.68–0.96) ^c	0.87 (0.73–1.03)	0.85 (0.70–1.02)
Work environment	0.65 (0.57–0.73) ^a	0.66 (0.58–0.74) ^a	0.69 (0.60–0.80) ^a
Systems do not help me to do my work in an efficient way
Comprehensive EHR	0.77 (0.65–0.91) ^b	0.82 (0.71–0.96) ^b	0.85 (0.73–1.00) ^c
Work environment	0.64 (0.57–0.72) ^a	0.65 (0.58–0.73) ^a	0.71 (0.63–0.80) ^a
Systems do not make it easy to share information in a timely way with other members of the health care team
Comprehensive EHR	0.60 (0.49–0.73) ^a	0.64 (0.53–0.77) ^a	0.64 (0.54–0.77) ^a
Work environment	0.65 (0.57–0.75) ^a	0.67 (0.59–0.77) ^a	0.76 (0.67–0.86) ^a
Nurses were not involved in choosing/modifying the patient record system
Comprehensive EHR	0.84 (0.69–1.03)	0.94 (0.80–1.11)	1.01 (0.86–1.18)
Work environment	0.50 (0.45–0.56) ^a	0.51 (0.45–0.57) ^a	0.59 (0.53–0.67) ^a
Quality of care on unit is fair or poor
Comprehensive EHR	0.67 (0.56–0.82) ^a	0.77 (0.67–0.88) ^a	0.83 (0.71–0.96) ^c
Work environment	0.44 (0.40–0.49) ^a	0.45 (0.41–0.50) ^a	0.47 (0.42–0.52) ^a
Poor patient safety grade (C, D, or F)
Comprehensive EHR	0.83 (0.71–0.97) ^c	0.94 (0.85–1.03)	0.98 (0.89–1.09)
Work environment	0.48 (0.44–0.52) ^a	0.48 (0.45–0.52) ^a	0.50 (0.46–0.54) ^a

Abbreviations: CBSA, core-based statistical area; CI, confidence interval; RN, registered nurse.

Notes: Odds ratios are from robust logistic regression models adjusted for hospital characteristics (size, teaching status, high-technology capability, ownership, CBSA type, state, and nurse staffing level), nurse characteristics (age, sex, highest level of education—baccalaureate in nursing or higher, and years of RN experience), and the clustering of nurses within hospitals. The odds ratio associated with the work environment can be interpreted as the difference in the odds of the nurse-reported outcome between hospitals with “better versus mixed” environments, and between hospitals with “mixed versus poor” environments.

p < 0.001.

p < 0.01.

p < 0.05.