Exploring the Impact of Electronic Medical Record-Enabled Versus Paper-Based Systems on the Quality of Nursing Handover: Comparative Case-Study

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: Not quantified - descriptive comparison only

• Primary Outcome: Quality of nursing handover measured by Clinical Handover Standard compliance

• Nnt Or Sensitivity: EMR wards showed more consistent clinical alerts communication and fewer interruptions; paper-based wards had higher bedside handover and patient engagement rates

• Confidence Interval: Not reported

Clinical Application

Findings suggest EMR implementation requires targeted design optimization and nursing informatics support Highly relevant to Australian public health services undergoing digital transformation, aligns with National Digital Health Strategy priorities Nursing staff in Australian public hospitals implementing or considering EMR systems

Abstract

BACKGROUND: Ineffective clinical handover has the potential to compromise patient safety and quality of care. Standardizing the handover process is a widely adopted improvement strategy intended to reduce failures of information transfer. By enabling real-time access to patient information, electronic medical records (EMRs) could address communication issues inherent to nursing handover. OBJECTIVE: This case study sought to compare the quality of nursing handover occurring at EMR-enabled sites with that occurring at paper-based sites, within a single Australian public health service. METHODS: A comparative case study design was used, using quantitative data collected from observational audits of 60 handovers and posthandover surveys conducted in EMR-enabled and paper-based ward environments. Handover quality was measured through compliance with the organization's Clinical Handover Standard and staff-reported perceptions, enabling comparison between cohorts. RESULTS: Compared with paper-based wards, EMR-enabled wards demonstrated more consistent communication of clinical alerts and risks and fewer interruptions, whereas paper-based wards showed higher rates of bedside handover and patient engagement. CONCLUSIONS: EMR implementation alone does not ensure high-quality nursing handover. EMR interface design and functionality may act as a barrier to bedside handover and patient engagement, and contribute to continued reliance on paper-based artifacts. Targeted EMR design and nursing informatics-led optimization are required to better support nursing handover as a complex and cognitively challenging communication process.

References

1. 1.Browning, L., Khan, U. R., Leggat, S., Monypenny, N., & Boyd, J. H. (2026). Exploring the Impact of Electronic Medical Record-Enabled Versus Paper-Based Systems on the Quality of Nursing Handover: Comparative Case-Study. JMIR Nursing, 9. https://doi.org/10.2196/85909