STEP-UP with Nurses: Impact of a Peer-Led Post-Implementation EHR Educational Series (STEP-UP)

Year Submitted: 2025
Published Date: 14 January 2026

Tags: Digitalisation, Technology, Learning Approach, Learning Culture, Training ＆ Education

About this Content

Aims

Peer-led teaching, which leverages shared clinical experience and cognitive congruence, was hypothesized to improve nurses' EHR acceptance and efficiency.

Background

Pre-implementation strategies are often deemed essential for a smooth Electronic Health Records (EHRs) transitions. However, the post-implementation phase is often overlooked despite its crucial role in sustaining adoption and optimising efficiency.

Methods

STEP-UP (System Training for EPIC Proficiency - Unleashing its Potential), a peer-led educational program, was implemented at Tan Tock Seng Hospital from January to April 2025. The program comprised three components: hospital-wide virtual sessions, unit-based discussions, and hands-on practice. Using convenience sampling, 528 participants were surveyed using the Unified Theory of Acceptance and Use of Technology (UTAUT), which evaluates five domains: performance expectancy, effort expectancy, social influence, facilitating conditions, and behavioral intention. One-way ANOVA and post-hoc test compared differences across session attendance, while system-generated EPIC utilization data evaluated documentation efficiency.

Results

Participants who completed all three sessions demonstrated significantly higher UTAUT scores than single-session attendees (MD=0.170.24, p 0.05) across overall UTUAT and all subdomains except performance expectancy. System utilization showed marked improvement, with Smartlink usage increasing from baseline (1155) to post-intervention (3288, +184.7%). The 4-month average EPIC active time per user per patient per day decreased from 9.29 minutes (September to December 2024) to 8.15 minutes (January to April 2025), representing a 12.3% improvement in documentation efficiency.

Conclusion

STEP-UP demonstrates that continuous peer-led training can significantly improve perceived EPIC efficiency and user acceptance. It presents a scalable model for sustaining EHR proficiency postimplementation and bridging nursing digital literacy gap implementation and bridging nursing digital literacy gaps.

Lessons Learnt

We learnt that sustainability in knowledge sharing comes from empowering colleagues, not relying solely on central trainers. This approach challenged traditional models and highlighted the value of collaboration in overcoming resource limitations. We also realized that fostering a culture of continuous digital learning is not just about technologyits about mindset. Encouraging curiosity and adaptability among nurses ensures long-term engagement with health innovations. High participant satisfaction reminded us that when learners feel supported and see relevance, digital learning becomes a catalyst for transformation. STEP-UP demonstrated that scalable models can drive both education and enthusiasm for health technology.

Keywords

Nursing, Efficiency, Productivity, NGEMR, EPIC Hyperspace

Innovators' Details

Connect with this contributor!

Aletheia - aletheia.xuanyu.lai@nhghealth.com.sg ↗ (opens in new tab)

Project Attachment

SHBC2025_SG-NR-01_Poster.pdf ↗ (opens in new tab)