Nursing Officers Attitudes Toward the implementation of Hospital Health Information Management System in Hospitals in Kalmunai RDHS

Background: Transition from paper-based health record systems to comprehensive electronic Hospital Health Information Management System is viewed as a means to improve both the quality of patient care and professional factors related to end-users. Objective: To Evaluate the attitudes and concerns towards implementation of electronic record system among Nursing Officers. Methods: A cross sectional study was conducted at RDHS Kalmunai among 95 nursing officers attached to four Base hospitals from October to November 2023. A pretested self-administered questionnaire was used to collect data related to demography and attitudes of nursing officers. Study analysis was performed using mean and percentages, Mann-Whitney U test and Spearman’s test. Results: 70.5% of the nurses were female and 47.8% of them were >39 years old. All had previous computer exposure and 67.45% of them had 1-2 years electronic system experience. Nurses attitude towards electronic health record system was positive (


Introduction
The healthcare sector is undergoing a transformative shift with the widespread adoption of Electronic Health Records (EHRs), evident in a 2021 Organization for Economic Co-operation and Development (OECD) survey of 27 countries [1] .This digital transition, driven by advancements in technology, is enhancing efficiency across healthcare processes [2] .EHR systems, currently at the forefront of implementation, digitally capture, store, and utilize patient information for more effective healthcare delivery [3] .EHRs facilitate data-driven clinical decision-DOI: https://doi.org/10.4038/sljma.v24i2.5422.The project was implemented at RDHS Kalmunai in 2017, and gradually extended to all four base hospitals in the region by 2022.
Transitioning to electronic health records aims to enhance patient care and factors affecting end-users.Considering the role of nursing officers (NOs) in healthcare institutes, the understanding of their perspectives on computerization is vital for successful implementation.Factors influencing acceptance and resistance must be grasped for the system's effective implementation, impacting job satisfaction, workload, skill development, personal responsibility, collaboration, and career trajectories.
NOs may face challenges in the effective implementation of HHIMS due to insufficient familiarity and training [6] .Potential resistance to technological change may hinder smooth adoption, when concerns about workflow, workload, and patient care responsibilities arise.Communication gaps between NOs and stakeholders could lead to misunderstandings, impacting their attitudes toward HHIMS.If NOs perceive a lack of tangible benefits or fail to appreciate its potential advantages in patient care and hospital management, their support for the system may hindered.Addressing these challenges is crucial for successful HHIMS integration in hospital settings.
Gaining insights into the key factors from the perspective of NOs is important, not only to prevent potential resistance but also to ensure successful integration of the innovative HHIMS.

General Objective:
To Evaluate the attitudes and concerns towards implementation of electronic record system among Nursing Officers.

Methodology
A descriptive cross-sectional study was conducted among NOs who were directly handling HHIMS in all four base hospitals in Kalmunai RDHS.'Nurses' Attitudes toward Computerization (NATC) Questionnaire' was used as the study instrument [6,7,8].The questionnaire has two sections.The first section encompassed demographic details, duration of HHIMS interaction, prior computer experience, and departmental service.
The second section comprised twenty Likert scale statements, which has a 5-point scale, representing five domains: benefit to the institution, patient care issues, superior capabilities of computers, willingness to use computers, and legal issues in computer use.
Data were analysed using the Statistical Package of Social Sciences (SPSS) version 25.The participants' attitudes were described by frequency analysis to view the percentage of positive versus negative attitudes toward using the HHIMS.Descriptive statistics were applied to describe the study's sample.Mann-Whitney U test and spearmen's rho test were used to examine the relationships between nurses' attitudes and demographic factors.

Results
A total of 92 NOs were recruited from 04 Base Hospital for the study.The majority of participants were females (70.5%), age > 39 (47.8%) and had work experience in the department more than 10 years (52.1%).All had previous computer experience, while majority (67.4%) had HHIMS experience for 1-2 years (Table1).
Nurses' attitudes toward using HHIMS according to the author's scoring guidelines, nurses' overall attitudes toward using computers were positive.
When analysing the mean scores for each item of the questionnaire, findings revealed that 58.6 % of NOs did not agree with the statement "Computers cause a decrease in communication between hospital departments", majority of NOs disagree with the statement 'Computers should only be used in the financial department'' (76.6%) and 54.3% of NOs agreed that paperwork for nurses has been greatly reduced by the use of computers.They also agreed computers allow the nursing staff to become more efficient (73.5 %).
Six statements out of twenty were perceived negatively by majority of NOs.Six statements were: "Part of the increase in costs of health care is because of computers" (65.2%), "Only one person at a time can use a computer terminal; therefore, staff efficiency is inhibited" (54.3%), "Computer increase the NOs work load" (54.3%), "Orientation for new employees takes longer because of computers and, therefore, unnecessary work delays occur" (54.3 %), "Because of computers, nurses will face more lawsuits" (74.9 %) and "Data entry in the computer  The analysis of the Mann-Whitney U test revealed no significant differences between males and females or nurses with and without previous computer skills experience in relation to their attitudes toward HHIMS; p values were (0.08 and 0.17 respectively).Spearman's rho correlation analysis was enrolled to determine the relationships between age, service in the department and period dealing with HHIMS and the total attitude scores.The findings revealed that there were no statistically significant correlations between nurses' attitude scores and age, service in the department and period dealing with HHIMS.The results of spearmen's rho test were (r = − 0.053, p = 0.202; r = -0.033,p = 0.294; r = -0.145,p = 0.052 respectively).

Discussion
Examining nurses' perspectives on HHIMS is vital for healthcare facilities.A thorough assessment of nurses' attitudes and influencing factors can inform the development of strategies to encourage those less willing to adopt the new electronic documentation system [9] .
Consistent with prior research [7,10,11] , this study's results also revealed a generally positive attitude among nurses toward computerization, as indicated by a high mean score.Additionally, 50.2% of NOs disagreed with the statement, "If I had my way, nurses would never have to use computers".Like the findings in Yontz et al. (2015) and Salameh et al. (2019) studies, this current investigation similarly discovered no association between age and the willingness to embrace computerization.This contrasts with the outcomes of Laramee et al. (2012) [12] study, where younger nurses showed more openness to EHR than their older counterparts, potentially attributed to their greater familiarity with technology and computers.
Further, current study showed gender did not influence attitude toward EHR acceptance.Some similar studies found that female nurses held more positive attitudes toward computerization [13,14] .Compare to the study findings of Mathew et al. (2014)  and Yontz et al. (2015) current study findings also revealed that there was no significant relationship between service in the department and attitudes toward computers usage for HHIMS.This finding indicated paper-based documentation system had a burden to all NOs.This was also supported by NOs agreement with computer usage would cause reduction in the paper work.
Despite the initial high costs associated with acquiring computers and software, the Health Ministry of Sri Lanka suggests that in the long term, healthcare expenses are anticipated to decrease [5] .During the initial implementation phase, nurses were in a learning stage, which might result in prolonged data entry and increased patient waiting time.However, as nurses gain experience, their efficiency was expected to improve, leading to faster performance.Though there were no legal concerns for nurses regarding the use of HHIMS, their misunderstanding caused the negative attitude.

Conclusion and Recommendation
The primary objective of this study was to assess nurses' attitudes towards computerized documentation.Irrespective of factors such as gender, age, work experience, computer proficiency, and familiarity with the implementation of HHIMS, nurses generally exhibited a positive disposition towards computerbased documentation.
To address any potential misunderstandings, an awareness program is recommended for nurses to enhance their adoption of the system.Additionally, frequent refresher training programs are suggested to enhance speed and proficiency.Nursing administrators should be involved from the planning phase to the final implementation of HHIMS.
It's crucial to note that the study exclusively focused on nurses.To gain a comprehensive understanding, it is recommended to explore the attitudes of other healthcare professionals who may have similar or divergent levels of acceptance towards computerized documentation.