Effect of using an electronic health record on interdisciplinary collaboration between professionals in care for youth, a mixed methods intervention study

Abstract

Background An interdisciplinary client-accessible electronic child health record (EPR-Youth) has been developed in the Netherlands with the aim of enhancing interdisciplinary collaboration between preventive child healthcare and youth care. Interdisciplinary collaboration contributing to integrated family care plans should counteract the rising costs in Dutch care for youth. So far, limited research is available about the contribution of client-accessible health records to interdisciplinary collaboration in child and adolescent care worldwide. Objective To investigate whether the use of EPR-Youth contributes to interdisciplinary collaboration between professionals in youth care and child healthcare. Methods In a mixed methods design, two partly overlapping samples of professionals completed questionnaires before introduction of EPR-Youth (n = 117) and 24 months thereafter (n = 127). Five components of interdisciplinary collaboration (interdependency, creation of new professional activities, flexibility, collective ownership of goals, and reflection on processes) were assessed. Halfway through the study period, two focus group interviews were held with professionals (n = 12), investigating the contribution of EPR-Youth to interdisciplinary collaboration. A linear mixed model was used to analyse differences between pre- and post-test measurements. Qualitative data were analysed using thematic analysis. Results Professionals reported significantly more positive about flexibility after introduction of EPR-Youth (n = 106, EMM = 4.00, 95%CI = 3.86–4.14) than before (n = 97, EMM = 3.79, 95%CI = 3.65–3.92), F (1, 100.7) = 1.97, p = 0.05. For the other components of collaboration as well as overall, professionals scored slightly, although not significantly, more positive after introduction of EPR-Youth than before. In line with these outcomes, focus group participants reported that use of EPR-Youth enhanced the sense of ‘interdependency’ and ‘collective ownership of goals’ and contributed to the ‘creation of new professional activities’. At baseline, differences in level of interdisciplinary collaboration were found between organizations, F(2, 134.0) = 7.17, p = 0.001, and between municipalities, F(4,130.8) = 3.80, p = 0.006. These findings were confirmed by focus group participants. Professionals attributed organizational differences to different facilitation of interdisciplinary collaboration. Conclusions This study suggests that using EPR-Youth might foster interdisciplinary collaboration. The different levels of interdisciplinary collaboration between organizations underline that implementing an EPR alone does not contribute to interdisciplinary collaboration: a shared vision and organizational facilities are needed to further strengthen interdisciplinary collaboration.