1. The influence of electronic health record use on collaboration among medical specialties
- Author
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Janita F.J. Vos, Marjolein van Offenbeek, Albert Boonstra, Arjen Kooistra, Marc A. Seelen, Research programme I&O, Value, Affordability and Sustainability (VALUE), Groningen Kidney Center (GKC), and Groningen Institute for Organ Transplantation (GIOT)
- Subjects
Knowledge management ,020205 medical informatics ,TEAMS ,Interprofessional Relations ,02 engineering and technology ,ORGANIZATION ,Health informatics ,Health administration ,03 medical and health sciences ,0302 clinical medicine ,Documentation ,ROUTINES ,health services administration ,0202 electrical engineering, electronic engineering, information engineering ,Collaborative affordances ,Medicine ,Outpatient clinic ,Humans ,Electronic health records ,030212 general & internal medicine ,Use ,health care economics and organizations ,INFORMATION-TECHNOLOGY ,business.industry ,Health Policy ,Nursing research ,lcsh:Public aspects of medicine ,Information technology ,lcsh:RA1-1270 ,CARE ,DOCUMENTATION ,Collaboration ,Information overload ,Workflow ,INTERDISCIPLINARY ,PAPER ,AFFORDANCE ,business ,Research Article - Abstract
Background One of the main objectives of Electronic Health Records (EHRs) is to enhance collaboration among healthcare professionals. However, our knowledge of how EHRs actually affect collaborative practices is limited. This study examines how an EHR facilitates and constrains collaboration in five outpatient clinics. Methods We conducted an embedded case study at five outpatient clinics of a Dutch hospital that had implemented an organization-wide EHR. Data were collected through interviews with representatives of medical specialties, administration, nursing, and management. Documents were analyzed to contextualize these data. We examined the following collaborative affordances of EHRs: (1) portability, (2) co-located access, (3) shared overviews, (4) mutual awareness, (5) messaging, and (6) orchestrating. Results Our findings demonstrate how an EHR will both facilitate and constrain collaboration among specialties and disciplines. Affordances that were inscribed in the system for collaboration purposes were not fully actualized in the hospital because: (a) The EHR helps health professionals coordinate patient care on an informed basis at any time and in any place but only allows asynchronous patient record use. (b) The comprehensive patient file affords joint clinical decision-making based on shared data, but specialty- and discipline-specific user-interfaces constrain mutual understanding of that data. Moreover, not all relevant information can be easily shared across specialties and outside the hospital. (c) The reduced necessity for face-to-face communication saves time but is experienced as hindering collective responsibility for a smooth workflow. (d) The EHR affords registration at the source and registration of activities through orders, but the heightened administrative burden for physicians and the strict authorization rules on inputting data constrain the flexible, multidisciplinary collaboration. (e) While the EHR affords a complete overview, information overload occurs due to the parallel generation of individually owned notes and the high frequency of asynchronous communication through messages of varying clinical priority. Conclusions For the optimal actualization of EHRs’ collaborative affordances in hospitals, coordinated use of these affordances by health professionals is a prerequisite. Such coordinated use requires organizational, technical, and behavioral adaptations. Suggestions for hospital-wide policies to enhance trust in both the EHR and in its coordinated use for effective collaboration are offered.
- Published
- 2020