The influence of Electronic Health Record use on collaboration among medical specialties

Abstract

<jats:title>Abstract</jats:title> <jats:p><jats:bold>Background: </jats:bold>One of the main objectives of<jats:bold> </jats:bold>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.<jats:bold>Methods: </jats:bold> We conducted an embedded case study at five multidisciplinary outpatient clinics of a Dutch hospital that had implemented an organization-wide EHR. Data were collected through semi-structured interviews with representatives of medical specialties, administration, nursing, and management. Documents were then analyzed to contextualize these data. We examined the following six collaborative affordances of EHRs: (1) portability, (2) co-located access, (3) shared overviews, (4) mutual awareness, (5) messaging, and (6) orchestrating.<jats:bold>Results: </jats:bold>Our findings demonstrate how an EHR will simultaneously 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 focal 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 full 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.<jats:bold>Conclusions: </jats:bold>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.</jats:p>

Factors influencing implementation of electronic health records system in Nyeri level 5 hospital

“…This finding agreed with Vos et al who summarized that Health-care providers must be able to obtain, comprehend, and authenticate one other's data. 30 The government's allocation of a separate fund for the deployment of the EHR system can make it less expensive for public hospitals and private clinics. 14 The aforementioned statement was supported by the study results which indicated that the information shared was used to allocate funds for health services delivery.…”

The Effect of the Electronic Health Record on Interprofessional Practice: A Systematic Review

“…In addition to limited knowledge on this topic, studies that have been completed provide a piecemeal view, that is, investigating effects of the EHR on one discipline only such as doctors or nurses, or focusing on one element of interprofessional practice such as coordination of patient care. 26,27,34,[38][39][40][41][42][43][44] The EHR has the potential to improve interprofessional practice, however, conflicting results are found within the literature, with disconnected teams and "information overload." 32…”

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

“…Research shows that interdisciplinary collaboration can be strengthened by interdisciplinary use of electronic health records. More speci cally, sharing information and knowledge, and drawing collaborative care plans in such an interdisciplinary used electronic health record could enhance the quality of care (7,8,9). On the other hand, some studies point out that electronic health records can inhibit collaboration as well, due to improper registration or a mismatch with working processes (10,11).…”