The electronic medical record and everyday medical work (original) (raw)
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Making a case in medical work: implications for the electronic medical record
… Cooperative Work (CSCW …, 2003
The introduction of the electronic medical record (EMR) is widely seen by healthcare policy makers and service managers alike as a key step in the achievement of more efficient and integrated healthcare services. However, our study of inter-service work practices reveals important discrepancies between the presumptions of the role of the EMR in achieving service integration and the ways in which medical workers actually use and communicate patient information. These lead us to doubt that technologies like the EMR can deliver their promised benefits unless there is a better understanding of the work they are intended to support and the processes used in its development and deployment become significantly more user-led.
Making a case in medical work: Implications for the electronic patient record
Computer Supported Cooperative …, 2003
The introduction of the electronic medical record (EMR) is widely seen by healthcare policy makers and service managers alike as a key step in the achievement of more efficient and integrated healthcare services. However, our study of inter-service work practices reveals important discrepancies between the presumptions of the role of the EMR in achieving service integration and the ways in which medical workers actually use and communicate patient information. These lead us to doubt that technologies like the EMR can deliver their promised benefits unless there is a better understanding of the work they are intended to support and the processes used in its development and deployment become significantly more user-led.
2002
We present findings from a study of information exchange practices between staff within different healthcare providers. Our findings suggest that healthcare policy makers' expectations that the electronic medical record (EMR) will quickly and necessarily result in more streamlined inter-organisational working are based on an inadequate understanding of the ways in which healthcare professionals actually use and communicate patient information. More generally, our findings reinforce the view that for new healthcare technologies like the EMR to deliver their promised benefits, healthcare staff need time to understand the possibilities that such technologies may afford their work, and help in adapting the technologies to match evolving requirements and work practices. We argue that this calls for an approach to the design and implementation of new healthcare technologies that is significantly more user-led than currently prevails.
Charting a New Course: Practical Considerations for Implementing an Electronic Health Records System
2008
To a startling extent, physicians today document their work in much the same way that physicians did in the nineteenth century. 1 Often, those unfamiliar with the United States's healthcare system and physician practices will assume that all physicians and hospitals have electronic health record ("EHR") systems that seamlessly share data as in other industries. The healthcare industry, however, spends a meager amount on information technology ("IT") compared to other industries. For example, the industry, as a whole, spends approximately two percent of gross revenues on IT compared with other industries that spend upwards of ten percent. 2
Electronic patient records in action
Health Informatics Journal, 2011
The implementation of generic models for organizing information in complex institutions like those in healthcare creates a gap between standardization and the need for locally relevant knowledge. The present study addresses how this gap can be bridged by focusing on the practical work of healthcare staff in transforming information in EPRs into knowledge that is useful for everyday work. Video recording of shift handovers on a rehabilitation ward serves as the empirical case. The results show how extensive selections and reorganizations of information in EPRs are carried out in order to transform information into professionally relevant accounts. We argue that knowledge about the institutional obligations and professional ways of construing information are fundamental for these transitions. The findings point to the need to consider the role of professional knowledge inherent in unpacking information in efforts to develop information systems intended to bridge between institutional and professional boundaries in healthcare.
The electronic elephant in the room: Physicians and the electronic health record
JAMIA Open
Objectives Determine the specific aspects of health information and communications technologies (HICT), including electronic health records (EHRs), most associated with physician burnout, and identify effective coping strategies. Materials and methods We performed a qualitative analysis of transcripts from 2 focus groups and a burnout assessment of ambulatory physicians—each at 3 different health care institutions with 3 different EHRs. Results Of the 41 clinicians, 71% were women, 98% were physicians, and 73% worked in primary care for an average of 11 years. Only 22% indicated sufficient time for documentation. Fifty-six percent noted “a great deal of stress” because of their job. Forty-two percent reported “poor” or “marginal” control over workload. Even though 90% reported EHR proficiency, 56% indicated EHR time at home was “excessive” or “moderately high.” Focus group themes included HICT “successes” where all patients’ information is accessible from multiple locations. HICT “s...
Integration of a nationally procured electronic health record system into user work practices
BMC Medical Informatics and Decision Making, 2012
Background: Evidence suggests that many small-and medium-scale Electronic Health Record (EHR) implementations encounter problems, these often stemming from users' difficulties in accommodating the new technology into their work practices. There is the possibility that these challenges may be exacerbated in the context of the larger-scale, more standardised, implementation strategies now being pursued as part of major national modernisation initiatives. We sought to understand how England's centrally procured and delivered EHR software was integrated within the work practices of users in selected secondary and specialist care settings. Methods: We conducted a qualitative longitudinal case study-based investigation drawing on sociotechnical theory in three purposefully selected sites implementing early functionality of a nationally procured EHR system. The complete dataset comprised semi-structured interview data from a total of 66 different participants, 38.5 hours of non-participant observation of use of the software in context, accompanying researcher field notes, and hospital documents (including project initiation and lessons learnt reports). Transcribed data were analysed thematically using a combination of deductive and inductive approaches, and drawing on NVivo8 software to facilitate coding. Results: The nationally led "top-down" implementation and the associated focus on interoperability limited the opportunity to customise software to local needs. Lack of system usability led users to employ a range of workarounds unanticipated by management to compensate for the perceived shortcomings of the system. These had a number of knock-on effects relating to the nature of collaborative work, patterns of communication, the timeliness and availability of records (including paper) and the ability for hospital management to monitor organisational performance. Conclusions: This work has highlighted the importance of addressing potentially adverse unintended consequences of workarounds associated with the introduction of EHRs. This can be achieved with customisation, which is inevitably somewhat restricted in the context of attempts to implement national solutions. The tensions and potential trade-offs between achieving large-scale interoperability and local requirements is likely to be the subject of continuous debate in England and beyond with no easy answers in sight.
Health Informatics Journal, 2010
The aim of this investigation was to assess helpful and challenging aspects of electronic health information with respect to clinical workflow and identify a set of characteristics that support patient care processes. We conducted 20 semi-structured interviews at a Veterans Affairs Medical Center, with a fully implemented electronic health record (EHR), and elicited positive and negative examples of how information