Perspectives on the Intersection of Electronic Health Records and Health Care Team Communication, Function, and Well-being

Abstract

ImportanceUnderstanding of the interplay between the electronic health record (EHR), health care team relations, and physician well-being is currently lacking. Approaches to cultivate interpersonal interactions may be necessary to complement advancements in health information technology with high-quality team function.ObjectiveTo examine ways in which the EHR, health care team functioning, and physician well-being intersect and interact.Design, Setting, and ParticipantsSecondary qualitative analysis of semistructured interview data from 2 studies used keyword-in-context approaches to identify excerpts related to teams. Thematic analysis was conducted using pattern coding, then organized using the relationship-centered organization model. Two health care organizations in California from March 16 to October 13, 2017, and February 28 to April 21, 2022, participated, with respondents including attending and resident physicians.Main Outcome and MeasuresAcross data sets, themes centered around the interactions between the EHR, health care team functioning, and physician well-being. The first study data focused on EHR-related distressing events and their role in attending physician and resident physician emotions and actions. The second study focused on EHR use and daily EHR irritants.ResultsThe 73 respondents included attending physicians (53 [73%]) and resident physicians (20 [27%]). Demographic data were not collected. Participants worked in ambulatory specialties (33 [45%]), hospital medicine (10 [14%]), and surgery (10 [14%]). The EHR was reported to be the dominant communication modality among all teams. Interviewees indicated that the EHR facilitates task-related communication and is well suited to completing simple, uncomplicated tasks. However, EHR-based communication limited the rich communication and social connection required for building relationships and navigating conflict. The EHR was found to negatively impact team function by promoting disagreement and introducing areas of conflict into team relationships related to medical-legal pressures, role confusion, and undefined norms around EHR-related communication. In addition, interviewees expressed that physician EHR-related distress affects interactions within the team, eroding team well-being.Conclusions and RelevanceIn this study, the EHR supported task-oriented and efficient communication among team members to get work done and care for patients; however, participants felt that the technology shifts attention away from the human needs of the care team that are necessary for developing relationships, building trust, and resolving conflicts. Interventions to cultivate interpersonal interactions and team function are necessary to complement the efficiency benefits of health information technology.

Experience of Health Care Professionals Using Digital Tools in the Hospital: Qualitative Systematic Review

“…[64] "...while others perceived it to be confusing and hard to use, since the technology was not tailored to their needs." [59] 5 (29) Feeling confused Positive moderator "...physicians who got EMR training had more knowledge about the system than their colleagues, which improved their attitude and motivation towards the system." [74] 11 (65) Sufficient training "The EMR implementation was described as successful by nurses when they felt that they had learned the system and adapted their ways of working and workflows."…”

“…To facilitate improvements in the user experience of EHR systems, strategies have been developed to empower clinicians to collaborate with local administrators, health IT personnel, and EHR developers [ 35 , 36 ]. However, a focus on usability and system design may neglect other important aspects and the effect of digital tools on other human interactions within complex clinical systems [ 29 ]. To gain a more comprehensive and mechanistic understanding of the impact of digitalization on clinician well-being, emotions, behaviors, and cognitive processes associated with the use of digital technologies must be explored [ 40 , 41 ].…”

“…The impact of digitalization, in particular the introduction of EHR, on clinician well-being has been extensively studied [29][30][31][32]. Early EHR implementations were shown to have a negative impact on clinician well-being, reducing job satisfaction and increasing rates of clinician burnout owing to poor system usability, misaligned job roles, and increasing workloads associated with documentation requirements [32,33].…”