Congrats!

Research on electronic health records (EHR) and workarounds just received a Top 3 Article of the Year from Management Communication Quarterly.  This was research from Ashley Barrett’s dissertation.

Here is a summary of our research:

Have you ever wondered what’s on the screen that your healthcare providers type into when you visit?  Most healthcare providers use these electronic health record systems to document and track patient care, and quite often patients also can access this information through an online portal.  While there are some very valuable reasons to use these systems, there are also some challenges.

We think of EHR access in terms of a connected triangle.  At the three points, there are patients, providers, and teams.  Patients notice the presence of these health information technologies when providers type into computers or portable technologies, like iPads.  The mere presence of these screens in patient rooms can change the communication between the patient and the provider.  But people often forget that EHR systems are also used by teams of care providers, and that creates a new level of complexity.

So, in reality, EHR systems are not fixed technologies; they need to be adapted to meet the needs of healthcare teams.

In the 1990’s and early 2000’s organizational scholars Marshall Scott Pool and Geraldine DeSanctis studied teams who were expected to use shared software systems.  Their research, across many different types of teams and organizations found that even when a technology designer thinks the software has everything a team needs, the team will still adapt it to meet their needs.  Think about your own mobile phone.  Do you really use every feature that the designers put into the device?  Furthermore, do you use it exactly like others around you?

One added complication with a team’s use of EHR systems is that they also interact face-to-face, even though the timing of those interactions is not necessarily predictable.  In this research, we found that when teams talk about the EHR system, those conversations influence how they use them and their attitudes.  For example, if team members are complaining about the system, that makes others more negative and they can view the implementation of an EHR system as unsuccessful.  But, if individuals make changes to the system, presumably to make it better fit their work environment, their attitudes are positive.

Now we’re going to use a word that could make some people shutter: workarounds.  Healthcare workers regularly create workarounds—either inside the EHR systems or through off-line practices—that help them make these systems work.  While we could view these system changes as problematic, past organizational research would suggest that this behavior is normal, and probably needed as teams interact with technologies.

An added complication to consider with EHR systems is that some providers—specifically specialists working in multiple hospitals—move between locations ,and, for example, they could have four different EHR vendors’ systems they need to work with.  Since the authors of this article do research in two different locations, Keri Stephens is in Austin, and Ashley Barrett is in Waco, they see clear differences between the interconnectedness of healthcare facilities in a given geographic community.  Waco is fairly centralized on EpicCare, while Austin healthcare facilities use a wide variety of vendors.

Many of the ideas about EHR systems, also apply to other health information technologies.  Healthcare providers use different mobile devices, mobile applications, and technology-communication tools specific to their profession.