Facilitating and constraining influences of an Electronic Health Record on collaboration among medical specialties



Collaboration among health professionals of the medical specialties involved in a patient stream is considered a key factor for achieving high quality clinical care. One major reason to implement comprehensive Electronic Health Records is to enhance such collaboration. However, in practice it appears that EHRs both promote and hinder collaboration, rendering EHR-enabled collaboration context dependent. Systematic knowledge on how the different EHR features actually affect collaborative practices is limited. Therefore, we are interested how the ways healthcare professionals communicate, and eventually collaborate, are influenced by the affordances of an EHR. In this study we examine facilitating and constraining influences on the actualization of an EHR’s inscribed collaborative affordances in five outpatient clinics.

We conducted an embedded case study at five multidisciplinary outpatient clinics of a Dutch hospital that recently implemented an organization-wide EHR. Data collection comprised semi-structured interviews with representatives of medical specialties, medical administration, nursing, and management. Documents were analyzed to contextualize these data. We examined the following six collaborative affordances of EHRs: (1) portability, (2) collocated access, (3) shared overview, (4) mutual awareness, (5) messaging and (6) orchestrating.

Results and Discussion:
Our findings unravel how an EHR can simultaneously have facilitating as well as constraining influences on collaboration between specialties and disciples. Consequently, collaborative affordances inscribed in the system were not fully actualized in the focal hospital. (a) The EHR helps health professionals in coordinating patient care on an informed basis any time and any place, as long as their patient record use is a-synchronous. (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 materials can be easily shared across specialties. (c) Reduced necessity of face-to-face communication saves time, but is experienced to hinder the collective responsibility for a smooth workflow. (d) The EHR affords registration at the source and full registration of activities through orders, yet the heightened administrative burden for physicians and the strict authorizations constrain the EHR affordance of 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 a-synchronous communication through messages varying in clinical priority.

For the full actualization of EHRs’ inscribed collaborative affordances in hospitals, health professionals’ coordinated use of these affordances is a prerequisite. To enable such coordinated use organizational, technical, and behavioral adaptations are required. Hospital-wide policies to enhance trust both in the EHR and in its coordinated use for effective collaboration are suggested.
Originele taal-2English
StatusPublished - 17-nov.-2020
EvenementEHMA 2020 Annual Conference: Health Management: realigning systems, contxt and players - Rotterdam, Netherlands
Duur: 17-nov.-202019-nov.-2020


ConferenceEHMA 2020 Annual Conference
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