# Impact of electronic health records on nursing workflow efficiency and predictive factors in Palestinian hospitals

## TL;DR

This study examines how electronic health records affect nursing workflow in Palestinian hospitals, finding that they improve efficiency but require better training and technical support.

## Contribution

This is the first study in Palestine to assess EHR impact on nursing workflow in government hospitals under challenging conditions.

## Key findings

- 70% of nurses reported high workflow efficiency with EHR use, citing faster access to patient information and reduced paperwork.
- 50.8% of nurses experienced workflow interruptions due to technical issues, highlighting the need for reliable systems.
- User-friendliness, training, and technical support were significant predictors of workflow efficiency.

## Abstract

Electronic Health Records (EHRs) have revolutionized patient care and data management, but their integration may disrupt workflow. Palestine recently introduced EHRs in their hospitals, yet no local data exist on nursing workflow. This study aims to assess the impact of EHRs on workflow efficiency and associated factors among nurses with direct paper-to-EHR transition experience. A quantitative, cross-sectional study design was employed. A convenience sample of 185 nurses was recruited from medical and surgical wards across selected hospitals. Data were collected via a structured questionnaire and analyzed using SPSS version 29 using descriptive statistics and multiple linear regressions, with significance set at p < 0.05. A total of 185 nurses participated, with the majority aged 25–34 years (61.6%). Most had 5–10 years of experience (42.2%). Overall, 70% of nurses reported high or very high workflow efficiency with EHR use (M = 3.59, SD = 0.75). EHRs were perceived to improve access to patient information (63.2%), reduce documentation time (63.8%), and support teamwork and communication, although 50.8% reported workflow interruptions due to technical issues. Multiple regression identified EHR user-friendliness (β = 0.261, p < 0.001), training (β = 0.243, p = 0.024), technical support (β = 0.184, p = 0.005), and age (β = –0.223, p = 0.037) as significant predictors of workflow efficiency. EHRs positively influence nurses’ workflow; transition-experienced nurses highlight usability and training as significant predictor factors. Enhancing these areas can optimize clinical performance.

This is the first study conducted in Palestine to explore the impact of Electronic Health Records (EHRs) on nurses’ day-to-day work in government hospitals. This study was conducted in the context of political tension, regular power outages, and limited resources. 185 nurses who transitioned directly from a paper-based record system to EHRs responded to the survey.

The vast majority (70%) of nurses indicated EHRs enhance their efficiency of work through faster access to patient information and reduced time spent on paperwork. Many respondents (50%) also experience organizational delays due to the system’s slow progress. Key organizational factors enhancing EHR efficiency include good usability, training, technical support, and younger age.

The findings demonstrate that digital technologies and digital systems can provide tremendous efficiencies for nurses even in extreme situations, but that successful implementation is contingent upon finding solutions to basic infrastructural challenges. Hospitals can use findings from this study to better target nurse-friendly implementations of EHR systems, ongoing education and training, and reliable backup systems, as these changes could help decrease stress and burnout as well as improve patient care. Our research contributes practical background information to an ongoing global discussion on EHRs in low-resource settings while also emphasizing the continued challenge of ensuring health technologies support frontline staff and care.