An Ethnographic Study of Health Information Technology Use in Three Intensive Care Units

Leslie, Myles; Paradis, Elise; Gropper, Michael A.; Kitto, Simon; Reeves, Scott; Pronovost, M.P.H. Peter

doi:10.1111/1475-6773.12466

Cited by 23 publications

(10 citation statements)

References 55 publications

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“…Our findings were consistent with common areas identified by usability studies of nursing documentation systems related to the long time for documentation and task completion, lack of data relevancy, and nurse perception of lack of system effect on quality of care [24,31,32,37,38]. Yet, our study was specific to the usability of a CPG-based care planning solution within the nursing documentation system and found a lack of system safety features as a major concern for nurses.…”

Section: Discussionsupporting

confidence: 87%

Nurses’ Perceptions of a Care Plan Information Technology Solution With Hundreds of Clinical Practice Guidelines in Adult Intensive Care Units: Survey Study

et al. 2019

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Background The integration of clinical practice guidelines (CPGs) into the nursing care plan and documentation systems aims to translate evidence into practice, improve safety and quality of care, and standardize care processes. Objective This study aimed to evaluate nurses’ perceptions of the usability of a nursing care plan solution that includes 234 CPGs. Methods A total of 100 nurses from 4 adult intensive care units (ICUs) responded to a survey measuring nurses’ perceptions of system usability. The survey included 37 rated items and 3 open-ended questions. Results Nurses’ perceptions were favorable with more than 60.0% (60/100) in agreement on 12 features of the system and negative to moderate with 20.0% (20/100), to 59.0% (59/100) in agreement on 19 features. The majority of the nurses (80/100, 80.0% to 90/100, 90.0%) agreed on 4 missing safety features within the system. More than half of the nurses believed they would benefit from refresher classes on system use. Overall satisfaction with the system was just above average (54/100, 54.0%). Common positive themes from the narrative data were related to the system serving as a reminder for complete documentation and individualizing patient care. Common negative aspects were related to duplicate charting, difficulty locating CPGs, missing unit-specific CPGs, irrelevancy of information, and lack of perceived system value on patient outcomes. No relationship was found between years of system use or ICU experience and satisfaction with the system ( P =.10 to P =.25). Conclusions Care plan systems in ICUs should be easy to navigate; support efficient documentation; present relevant, unit-specific, and easy-to-find information; endorse interdisciplinary communication; and improve safety and quality of care.

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Section: Discussionsupporting

confidence: 87%

Nurses’ Perceptions of a Care Plan Information Technology Solution With Hundreds of Clinical Practice Guidelines in Adult Intensive Care Units: Survey Study

et al. 2019

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“…[7][8][9] However, studies suggest that unintended consequences have emerged, including clinician frustration with EHRs and the large amount of time spent working in these systems. [10][11][12][13][14][15] Use of EHRs has been associated with decreased job satisfaction and burnout among clinicians [16][17][18][19][20] as well as disruptions of clinician-patient relationships. 11, [21][22][23][24] In addition, EHRs enable clinicians to work outside of the physical walls of their facilities, resulting in so-called desktop medicine that expands to after-hours work.…”

mentioning

confidence: 99%

Assessment of Electronic Health Record Use Between US and Non-US Health Systems

et al. 2021

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IMPORTANCE Understanding how the electronic health record (EHR) system changes clinician work, productivity, and well-being is critical. Little is known regarding global variation in patterns of use. OBJECTIVE To provide insights into which EHR activities clinicians spend their time doing, the EHR tools they use, the system messages they receive, and the amount of time they spend using the EHR after hours.

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“…However, EHRs have also been identified as constraining medical work [ 9 ], including collaboration [ 10 – 13 ]. Studies have addressed unanticipated problems such as alert fatigue [ 14 ], paper persistence [ 15 ], workflow mismatches [ 16 ] and time consuming system demands [ 17 – 19 ] resulting in reduced face-to-face patient care [ 20 ] making EHR-enabled collaboration troublesome and highly context dependent [ 21 ]. Given this situation, we are interested in how healthcare professionals interact and communicate, and eventually collaborate or are constrained in their collaboration as a result of the affordances offered by an EHR [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

The influence of electronic health record use on collaboration among medical specialties

Vos

Boonstra

Kooistra

et al. 2020

BMC Health Serv Res

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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.

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An Ethnographic Study of Health Information Technology Use in Three Intensive Care Units

Cited by 23 publications

References 55 publications

Nurses’ Perceptions of a Care Plan Information Technology Solution With Hundreds of Clinical Practice Guidelines in Adult Intensive Care Units: Survey Study

Nurses’ Perceptions of a Care Plan Information Technology Solution With Hundreds of Clinical Practice Guidelines in Adult Intensive Care Units: Survey Study

Assessment of Electronic Health Record Use Between US and Non-US Health Systems

The influence of electronic health record use on collaboration among medical specialties

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