Mapping communication spaces: The development and use of a tool for analyzing the impact of EHRs on interprofessional collaborative practice

Rashotte, Judy; Varpio, Lara; Day, Kathleen; Parush, Avi; Elliott-Miller, Pat; King, James W.; Roffey, Tyson

doi:10.1016/j.ijmedinf.2016.05.003

Cited by 13 publications

(9 citation statements)

References 32 publications

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“…Communication is a foundation of effective interprofessional collaborative practice (Rashotte et al, 2016) and a cornerstone of high-quality, safe patient care. Alternatively, miscommunication between healthcare professionals is cited as a root cause in up to 80% of adverse events and serious medical errors (Glymph et al, 2015; Rabol et al, 2011) many of which are considered preventable.…”

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confidence: 99%

“…In healthcare, the physical environment is one of a number of interrelated factors that either facilitates or hinders effective teamwork and communication between professional groups (Dean, Gill, & Barbour, 2016; Gharaveis, Hamilton, & Pati, 2017; Kalisch & Begeny, 2005). Cultural and social factors are often intertwined with macro and microdesign elements and the spatial environment to jointly affect collaborative work processes and outcomes (Becker & Steele, 1995; Rashotte et al, 2016). To date, the effect of the physical environment (e.g., size of spaces, visual designs, and layout of work stations and corridors) on communication patterns, particularly informal communication, in busy clinical settings has received little attention.…”

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confidence: 99%

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The Influence of Spatial Design on Team Communication in Hospital Emergency Departments

Naccarella

Raggatt

Redley

2018

HERD

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Objective: To identify spatial design factors that influence informal interprofessional team-based communication within hospital emergency departments (EDs). Background: Effective team communication in EDs is critical for interprofessional collaborative care and prevention of serious errors due to miscommunication. Limited evidence exists about how informal communication in EDs is shaped by the physical workspace and how workplace design principles can improve the quality of ED team communication. Method: Two health services with four hospital sites in Victoria, Australia, participated. A multistage mixed-methods approach used (1) an anonymous online communication network survey ( N = 103) to collect data on patterns and locations of informal interprofessional team communication among ED staff, (2) focus groups ( N = 37) and interviews ( N = 3) using photoelicitation to understand the perspectives of ED staff about how spatial design influences team communication, and (3) validity testing of preliminary findings with executives and ED managers at the participating sites. Results: Informal communication with peers and within discipline groups on nonspecific areas of the ED was most common. Three key factors influenced the extent to which ED workspaces facilitated informal communication: (1) staff perceptions of privacy, (2) staff perceptions of safety, and (3) staff perceptions of connectedness to ED activity. Conclusion: Our research supports the proposition that ED physical environments influence informal team communication patterns. To facilitate effective team communication, ED workspace spatial designs need to provide visibility and connectedness, support and capture “case talk,” enable privacy for “comfort talk,” and optimize proximity to patients without compromising safety.

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confidence: 99%

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confidence: 99%

The Influence of Spatial Design on Team Communication in Hospital Emergency Departments

Naccarella

Raggatt

Redley

2018

HERD

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“…In addition, we built the assumptions of full editability and collaboration into the core of the system design. Fully collaborative documentation systems have previously been discussed in different contexts [ 27 ], and many studies have pointed out how EMR design paradigms can facilitate or block collaboration between clinicians [ 28 , 29 ]. Our work builds on these discussions, and we believe that fully collaborative documentation systems are a key step in reducing documentation burden and information overload.…”

Section: Discussionmentioning

confidence: 99%

A Fully Collaborative, Noteless Electronic Medical Record Designed to Minimize Information Chaos: Software Design and Feasibility Study

et al. 2021

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Background Clinicians spend large amounts of their workday using electronic medical records (EMRs). Poorly designed documentation systems contribute to the proliferation of out-of-date information, increased time spent on medical records, clinician burnout, and medical errors. Beyond software interfaces, examining the underlying paradigms and organizational structures for clinical information may provide insights into ways to improve documentation systems. In particular, our attachment to the note as the major organizational unit for storing unstructured medical data may be a cause of many of the problems with modern clinical documentation. Notes, as currently understood, systematically incentivize information duplication and information scattering, both within a single clinician’s notes over time and across multiple clinicians’ notes. Therefore, it is worthwhile to explore alternative paradigms for unstructured data organization. Objective The aim of this study is to demonstrate the feasibility of building an EMR that does not use notes as the core organizational unit for unstructured data and which is designed specifically to disincentivize information duplication and information scattering. Methods We used specific design principles to minimize the incentive for users to duplicate and scatter information. By default, the majority of a patient’s medical history remains the same over time, so users should not have to redocument that information. Clinicians on different teams or services mostly share the same medical information, so all data should be collaboratively shared across teams and services (while still allowing for disagreement and nuance). In all cases where a clinician must state that information has remained the same, they should be able to attest to the information without redocumenting it. We designed and built a web-based EMR based on these design principles. Results We built a medical documentation system that does not use notes and instead treats the chart as a single, dynamically updating, and fully collaborative workspace. All information is organized by clinical topic or problem. Version history functionality is used to enable granular tracking of changes over time. Our system is highly customizable to individual workflows and enables each individual user to decide which data should be structured and which should be unstructured, enabling individuals to leverage the advantages of structured templating and clinical decision support as desired without requiring programming knowledge. The system is designed to facilitate real-time, fully collaborative documentation and communication among multiple clinicians. Conclusions We demonstrated the feasibility of building a non–note-based, fully collaborative EMR system. Our attachment to the note as the only possible atomic unit of unstructured medical data should be reevaluated, and alternative models should be considered.

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“…Collaboration is needed for an effective, skilled, integrated health care system (Reeves et al, 2017), resulting in holistic, person-centered care (Dodge et al, 2018), improved access to services (Mason et al, 2015) and improved quality of care (NHS, 2019). For integrated care to be effective the inter-professional relationship needs to be of a high quality, with communication being the foundation of a functioning team (Rashotte et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

Would integrating women's professional care of pelvic organ prolapse improve the symptoms and quality of life: an integrative literature review

Davies

Burdett

2020

JICA

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PurposeIntegrated healthcare is a central tenant of the NHS Long Term Plan (NHS, 2019). NICE in 2019 published guidelines; advising the integration of multidisciplinary professionals which may lead to an improvement in conservative treatment methods of pelvic organ prolapse. Therefore, current literature on the conservative treatments for pelvic organ prolapse needs to be reviewed to ascertain if an integrated approach would improve the symptoms and quality of life for women.Design/methodology/approachA systematic review of the literature between 2013 and 2018 was implemented. Papers included were written in English, peer-reviewed and consisted of treatments of pelvic organ prolapse in women. Papers containing surgical interventions, postpartum participants, reviews, evaluations, guidelines, follow-up studies, focusing on cost effectiveness, sexual function were excluded.FindingsSeven studies in total were included, and two overarching themes were identified: quality of life after treatment and the effect of conservative treatment on pelvic organ prolapse symptoms. The literature suggested that integrating care had a more positive outcome on pelvic organ symptoms and quality of life.Research limitations/implicationsTo develop a robust enhanced model of care for conservative treatment of pelvic organ prolapse through more mixed method or qualitative research, that incorporates integrative treatment methods with collaboration from multidisciplinary professionals.Practical implicationsThe practical implications of integrating the conservative management of pelvic organ prolapse is the communication between the multidisciplinary team must be exceptional to ensure everyone understands and agrees the treatment that is being provided to patient. Also, effective teamwork is important to ensure the patient receives the best care with input from the correct disciplines. The multi-professional team will need to have regular meetings to discuss and implement care plans for patients that might prove difficult to schedule due to differing commitments and priorities. This must be overcome to insure a successful and effective integrated approach to pelvic organ prolapse is delivered.Social implicationsThe social implications of integrating the professional approach to women's care of pelvic organ prolapse involves reducing the severity of the symptoms therefore, increasing the quality of life. This may result in the reduction of surgical intervention due to the patient being satisfied with the conservative management. Through integrating the management of the prolapse the patient will receive an accessible individualised care plan pathway that focuses on treating or reducing the impact of the symptoms that are bothersome to the patient whilst managing patient expectations. Patients will also, be reassured by the number of multi-disciplinary professionals involved in their care.Originality/valueGlobal integration of conservative treatments and multidisciplinary-professionals specialising in pelvic organ prolapse and pelvic floor dysfunction is needed.

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Mapping communication spaces: The development and use of a tool for analyzing the impact of EHRs on interprofessional collaborative practice

Cited by 13 publications

References 32 publications

The Influence of Spatial Design on Team Communication in Hospital Emergency Departments

The Influence of Spatial Design on Team Communication in Hospital Emergency Departments

A Fully Collaborative, Noteless Electronic Medical Record Designed to Minimize Information Chaos: Software Design and Feasibility Study

Would integrating women's professional care of pelvic organ prolapse improve the symptoms and quality of life: an integrative literature review

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