INTEGRATING THEORIES FROM MEDICINE AND INFORMATION TECHNOLOGY (IT) TO ANALYZE DIFFUSION OF ELECTRONIC MEDICAL RECORDS IN PRIMARY CARE

The implications of the physician-patient relationship and communication on healthcare quality have been widely discussed in previous research. Communication has been characterized as one of the most powerful, encompassing, and versatile instruments available to the physician and it has been suggested that good physician-patient communication can improve healthcare outcomes. The incorporation of Information Systems (IS) in healthcare and more specifically, the introduction of Electronic Medical Recordss (EMRs) in primary care provide an opportunity for improving healthcare services and quality of care. Healthcare IS has without a doubt transformed the dynamics of the medical encounter. Implications of EMRs on the physician-patient communication, and thus on healthcare quality have not yet reached a full understanding. In this paper we suggest that constructs from several relevant and important theoretical frameworks from the IS field should be applied in order to enhance understanding of the EMR\u27s effect on the medical encounter. These theories include: Task-Technology Fit, Technology Acceptance, Technology to Performance Chain, Post Acceptance Model. Our thesis suggests that these theories and the constructs that they include can and should be applied in the field of healthcare IS because of the complexity entailed in the field of healthcare. As such, we suggest a theoretical model that aims to assist in basing a deeper understanding of the physician-patient relationship in a computerized environment

Assessing EHR use during hospital morning rounds: A multi-faceted study.

BackgroundThe majority of U.S hospitals have implemented electronic health records (EHRs). While the benefits of EHRs have been widely touted, little is known about their effects on inpatient care, including how well they meet workflow needs and support care.ObjectiveAssess the extent to which EHRs support care team workflow during hospital morning rounds.DesignWe applied a mixed-method approach including observations of care teams during morning rounds, semi-structured interviews and an electronic survey of hospital inpatient clinicians. Structured field notes taken during observations were used to identify workflow patterns for analysis. We applied a grounded theory approach to extract emerging themes from interview transcripts and used SPSS Statistics 24 to analyze survey responses.SettingMedical units at a major teaching hospital in New England.ResultsData triangulation across the three analyses yielded four main findings: (1) a high degree of variance in the ways care teams use EHRs during morning rounds. (2) Pervasive use of workarounds at critical points of care (3) EHRs are not used for information sharing and frequently impede intra-care team communication. (4) System design and hospital room settings do not adequately support care team workflow.ConclusionsGaps between EHR design and the functionality needed in the complex inpatient environment result in lack of standardized workflows, extensive use of workarounds and team communication issues. These issues pose a threat to patient safety and quality of care. Possible solutions need to include improvements in EHR design, care team training and changes to the hospital room setting