# EHR usability and usefulness, perceived missed nursing care and medication errors in critical care

> **NIH AHRQ R01** · UNIVERSITY OF MARYLAND BALTIMORE · 2022 · $392,290

## Abstract

PROJECT ABSTRACT:
Nurses spend an average of one-third of their patient care time interacting with the electronic health record
(EHR), and high nursing workloads can lead to missed nursing care essential for patient safety and quality of
care, and increase the odds of medication errors, which can be deadly. However, there has been a lack of
studies of EHR burden on nurses, even though over 90% were dissatisfied with inpatient EHR use, burden,
time demands, and had doubts about EHR impact on patient care quality and safety. This indicates a critical
need to comprehensively examine EHR usability and usefulness and to develop effective, well thought out
solutions using a human factors and systems engineering approach. However, the limited studies typically
examine a single aspect of usability/usefulness, and very few link nurse EHR to patient safety and quality
outcomes. To address these research gaps, we propose a 5-year, prospective, multi-site, mixed-method field
study with the following aims: 1-to understand and comprehensively evaluate nurse EHR usability and
usefulness, using micro- and macro-level measures, that include process mapping of nurse EHR clinical
workflow, EHR data analytics (e.g., EPIC reports-time stamps, task/page sequencing), structured interviews,
targeted observations and nurse surveys, with consideration of EHR structure (functionality, interoperability); 2-
to measure real-time usability with mobile monitoring (via eye-tracking glasses) with time-stamped EPIC
reports, followed by cognitive interviews post-monitoring to obtain details on EHR challenges and flow
decisions; 3- to examine the impact of EHR usability and usefulness on nurse-perceived patient safety (missed
nursing care, medication errors), accounting for various dimensions of nursing workload (e.g., cognitive,
physical, temporal), and clinical nursing workflow. Finally, we will conduct a proactive risk analysis of 3 key
EHR-supported clinical nursing workflow processes. The study addresses AHRQ priorities by identifying
potential “root causes of threats to patient safety,” noted by the Healthcare Safety & Quality Improvement
Research (HSQR) section, through the study’s focus on reducing nursing EHR burden, perceived missed
nursing care and medication errors.

## Key facts

- **NIH application ID:** 10503493
- **Project number:** 1R01HS029011-01
- **Recipient organization:** UNIVERSITY OF MARYLAND BALTIMORE
- **Principal Investigator:** AYSE PINAR GURSES
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2022
- **Award amount:** $392,290
- **Award type:** 1
- **Project period:** 2022-08-01 → 2027-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10503493

## Citation

> US National Institutes of Health, RePORTER application 10503493, EHR usability and usefulness, perceived missed nursing care and medication errors in critical care (1R01HS029011-01). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10503493. Licensed CC0.

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