Download PDF
Appl Clin Inform 2022; 13(03): 541-559
DOI: 10.1055/s-0042-1748855
Review Article

The Effect of the Electronic Health Record on Interprofessional Practice: A Systematic Review

Samantha T. Robertson
1   School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
2   Sunshine Coast Hospital and Health Service, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
3   Digital Health CRC, Sydney, New South Wales, Australia
,
Ingrid C.M. Rosbergen
4   Surgical Treatment and Rehabilitation Service (STARS), School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
5   Surgical Treatment and Rehabilitation Service (STARS), Metro North Hospital and Health Service, Herston, Brisbane, Australia
,
Andrew Burton-Jones
6   School of Business, University of Queensland, Brisbane, Australia
,
Rohan S. Grimley
2   Sunshine Coast Hospital and Health Service, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
7   Sunshine Coast Clinical School, School of Medicine, University of Queensland, Brisbane, Australia
,
Sandra G. Brauer
1   School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
› Author Affiliations Funding This research was supported by the Digital Health CRC and Queensland Health research grant “Bringing Digital Excellence to Clinical Excellence: Leading Digital Excellence in Queensland Health.” Digital Health CRC Limited is funded under the Commonwealth Government's Cooperative Research Centres Program.
› Further Information
   Permissions and Reprints

Abstract

Background Interprofessional practice and teamwork are critical components to patient care in a complex hospital environment. The implementation of electronic health records (EHRs) in the hospital environment has brought major change to clinical practice for clinicians which could impact interprofessional practice.

Objectives The aim of the study is to identify, describe, and evaluate studies on the effect of an EHR or modification/enhancement to an EHR on interprofessional practice in a hospital setting.

Methods Seven databases were searched including PubMed, Scopus, Web of Science, CINAHL, Cochrane, EMBASE, and ACM Digital Library until November 2021. Subject heading and title/abstract searches were undertaken for three search concepts: “interprofessional” and “electronic health records” and “hospital, personnel.” No date limits were applied. The search generated 5,400 publications and after duplicates were removed, 3,255 remained for title/abstract screening. Seventeen studies met the inclusion criteria and were included in this review. Risk of bias was quantified using the Quality Assessment Tool for Studies with Diverse Designs. A narrative synthesis of the findings was completed based on type of intervention and outcome measures which included: communication, coordination, collaboration, and teamwork.

Results The majority of publications were observational studies and of low research quality. Most studies reported on outcomes of communication and coordination, with few studies investigating collaboration or teamwork. Studies investigating the EHR demonstrated mostly negative or no effects on interprofessional practice (23/31 outcomes; 74%) in comparison to studies investigating EHR enhancements which showed more positive results (20/28 outcomes; 71%). Common concepts identified throughout the studies demonstrated mixed results: sharing of information, visibility of information, closed-loop feedback, decision support, and workflow disruption.

Conclusion There were mixed effects of the EHR and EHR enhancements on all outcomes of interprofessional practice, however, EHR enhancements demonstrated more positive effects than the EHR alone. Few EHR studies investigated the effect on teamwork and collaboration.

Keywords

electronic health records - interdisciplinary teams - interprofessional practice - hospitals

Protection of Human and Animal Subjects

No human subjects were involved in this study.




Publication History

Received: 24 December 2021

Accepted: 28 March 2022

Article published online:
01 June 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Alami H, Lehoux P, Gagnon MP, Fortin JP, Fleet R, Ag Ahmed MA. Rethinking the electronic health record through the quadruple aim: time to align its value with the health system. BMC Med Inform Decis Mak 2020; 20 (01) 32
    CrossrefPubMedGoogle Scholar
  • 2 Wager KA, Lee FW, Glaser JP. Health Care Information Systems. 4th ed.. Somerset: John Wiley & Sons, Incorporated; 2017
    Google Scholar
  • 3 Kuhn T, Basch P, Barr M, Yackel T. Medical Informatics Committee of the American College of Physicians. Clinical documentation in the 21st century: executive summary of a policy position paper from the American College of Physicians. Ann Intern Med 2015; 162 (04) 301-303
    CrossrefPubMedGoogle Scholar
  • 4 Dow AW, Zhu X, Sewell D, Banas CA, Mishra V, Tu SP. Teamwork on the rocks: rethinking interprofessional practice as networking. J Interprof Care 2017; 31 (06) 677-678
    CrossrefPubMedGoogle Scholar
  • 5 Körner M. Interprofessional teamwork in medical rehabilitation: a comparison of multidisciplinary and interdisciplinary team approach. Clin Rehabil 2010; 24 (08) 745-755
    CrossrefPubMedGoogle Scholar
  • 6 Morley L, Cashell A. Collaboration in health care. J Med Imaging Radiat Sci 2017; 48 (02) 207-216
    CrossrefPubMedGoogle Scholar
  • 7 Reeves S, Xyrichis A, Zwarenstein M. Teamwork, collaboration, coordination, and networking: why we need to distinguish between different types of interprofessional practice. J Interprof Care 2018; 32 (01) 1-3
    CrossrefPubMedGoogle Scholar
  • 8 Salas E, Wilson KA, Murphy CE, King H, Salisbury M. Communicating, coordinating, and cooperating when lives depend on it: tips for teamwork. Jt Comm J Qual Patient Saf 2008; 34 (06) 333-341
    PubMedGoogle Scholar
  • 9 Weller J, Boyd M, Cumin D. Teams, tribes and patient safety: overcoming barriers to effective teamwork in healthcare. Postgrad Med J 2014; 90 (1061): 149-154
    CrossrefPubMedGoogle Scholar
  • 10 Rosen MA, DiazGranados D, Dietz AS. et al. Teamwork in healthcare: key discoveries enabling safer, high-quality care. Am Psychol 2018; 73 (04) 433-450
    CrossrefPubMedGoogle Scholar
  • 11 World Health Organization. Framework for Action on Interprofessional Education and Collaborative Practice. Geneva: World Health Organization; 2010
    Google Scholar
  • 12 Xyrichis A, Reeves S, Zwarenstein M. Examining the nature of interprofessional practice: an initial framework validation and creation of the InterProfessional Activity Classification Tool (InterPACT). J Interprof Care 2018; 32 (04) 416-425
    CrossrefPubMedGoogle Scholar
  • 13 Bolton R, Logan C, Gittell JH. Revisiting relational coordination: a systematic review. J Appl Behav Sci 2021; 57 (03) 290-322
    CrossrefPubMedGoogle Scholar
  • 14 Gittell JH. Relational Coordination: coordinating work through relationships of shared goals, shared knowledge and mutual respect. In: Kyriakidou O, Ozbilgin M. eds. Relational Perspectives in Organizational Studies: A Research Companion. Edward Elgar Publishers; 2006
    Google Scholar
  • 15 Gittell JH, Godfrey M, Thistlethwaite J. Interprofessional collaborative practice and relational coordination: improving healthcare through relationships. J Interprof Care 2013; 27 (03) 210-213
    CrossrefPubMedGoogle Scholar
  • 16 Lutfiyya MN, Chang LF, McGrath C, Dana C, Lipsky MS. The state of the science of interprofessional collaborative practice: a scoping review of the patient health-related outcomes based literature published between 2010 and 2018. PLoS One 2019; 14 (06) e0218578
    CrossrefPubMedGoogle Scholar
  • 17 Buljac-Samardzic M, Doekhie KD, van Wijngaarden JDH. Interventions to improve team effectiveness within health care: a systematic review of the past decade. Hum Resour Health 2020; 18 (01) 2
    Google Scholar
  • 18 Reeves S, Pelone F, Harrison R, Goldman J, Zwarenstein M. Interprofessional collaboration to improve professional practice and healthcare outcomes. Cochrane Database Syst Rev 2017; 6 (06) CD000072-CD72
    PubMedGoogle Scholar
  • 19 Zwarenstein M, Goldman J, Reeves S. Interprofessional collaboration: effects of practice-based interventions on professional practice and healthcare outcomes. Cochrane Database Syst Rev 2009; 3 (03) CD000072
    PubMedGoogle Scholar
  • 20 Herzberg S, Hansen M, Schoonover A. et al. Association between measured teamwork and medical errors: an observational study of prehospital care in the USA. BMJ Open 2019; 9 (10) e025314
    CrossrefPubMedGoogle Scholar
  • 21 Green BN, Johnson CD. Interprofessional collaboration in research, education, and clinical practice: working together for a better future. J Chiropr Educ 2015; 29 (01) 1-10
    CrossrefPubMedGoogle Scholar
  • 22 Kuziemsky CE, Borycki EM, Purkis ME. et al; Interprofessional Practices Team. An interdisciplinary team communication framework and its application to healthcare ‘e-teams’ systems design. BMC Med Inform Decis Mak 2009; 9: 43
    CrossrefPubMedGoogle Scholar
  • 23 Schmutz J, Manser T. Do team processes really have an effect on clinical performance? A systematic literature review. Br J Anaesth 2013; 110 (04) 529-544
    CrossrefPubMedGoogle Scholar
  • 24 Holden RJ, Binkheder S, Patel J, Viernes SHP. Best practices for health informatician involvement in interprofessional health care teams. Appl Clin Inform 2018; 9 (01) 141-148
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Schot E, Tummers L, Noordegraaf M. Working on working together. A systematic review on how healthcare professionals contribute to interprofessional collaboration. J Interprof Care 2020; 34 (03) 332-342
    CrossrefPubMedGoogle Scholar
  • 26 Bardach SH, Real K, Bardach DR. Perspectives of healthcare practitioners: an exploration of interprofessional communication using electronic medical records. J Interprof Care 2017; 31 (03) 300-306
    CrossrefPubMedGoogle Scholar
  • 27 Taylor SP, Ledford R, Palmer V, Abel E. We need to talk: an observational study of the impact of electronic medical record implementation on hospital communication. BMJ Qual Saf 2014; 23 (07) 584-588
    CrossrefPubMedGoogle Scholar
  • 28 Wu RC, Tran K, Lo V. et al. Effects of clinical communication interventions in hospitals: a systematic review of information and communication technology adoptions for improved communication between clinicians. Int J Med Inform 2012; 81 (11) 723-732
    CrossrefPubMedGoogle Scholar
  • 29 Smith CNC, Quan SD, Morra D. et al. Understanding interprofessional communication: a content analysis of email communications between doctors and nurses. Appl Clin Inform 2012; 3 (01) 38-51
    Article in Thieme ConnectPubMedGoogle Scholar
  • 30 Gross AH, Leib RK, Tonachel A. et al. Teamwork and electronic health record implementation: a case study of preserving effective communication and mutual trust in a changing environment. J Oncol Pract 2016; 12 (11) 1075-1083
    CrossrefPubMedGoogle Scholar
  • 31 Eden R, Burton-Jones A, Grant J, Collins R, Staib A, Sullivan C. Digitising an Australian university hospital: qualitative analysis of staff-reported impacts. Aust Health Rev 2020; 44 (05) 677-689
    CrossrefPubMedGoogle Scholar
  • 32 Furlow B. Information overload and unsustainable workloads in the era of electronic health records. Lancet Respir Med 2020; 8 (03) 243-244
    CrossrefPubMedGoogle Scholar
  • 33 Harrison MI, Koppel R, Bar-Lev S. Unintended consequences of information technologies in health care–an interactive sociotechnical analysis. J Am Med Inform Assoc 2007; 14 (05) 542-549
    CrossrefPubMedGoogle Scholar
  • 34 Bates DW. Health information technology and care coordination: the next big opportunity for informatics?. Yearb Med Inform 2015; 10 (01) 11-14
    Article in Thieme ConnectPubMedGoogle Scholar
  • 35 Collinsworth AW, Masica AL, Priest EL. et al. Modifying the electronic health record to facilitate the implementation and evaluation of a bundled care program for intensive care unit delirium. EGEMS (Wash DC) 2014; 2 (01) 1121
    PubMedGoogle Scholar
  • 36 Mazur LM, Mosaly PR, Moore C, Marks L. Association of the usability of electronic health records with cognitive workload and performance levels among physicians. JAMA Netw Open 2019; 2 (04) e191709
    CrossrefPubMedGoogle Scholar
  • 37 Holmgren AJ, Pfeifer E, Manojlovich M, Adler-Milstein J. A novel survey to examine the relationship between health IT adoption and nurse-physician communication. Appl Clin Inform 2016; 7 (04) 1182-1201
    Article in Thieme ConnectPubMedGoogle Scholar
  • 38 Vos JFJ, Boonstra A, Kooistra A, Seelen M, van Offenbeek M. The influence of electronic health record use on collaboration among medical specialties. BMC Health Serv Res 2020; 20 (01) 676
    CrossrefPubMedGoogle Scholar
  • 39 Graetz I, Reed M, Shortell SM, Rundall TG, Bellows J, Hsu J. The association between EHRs and care coordination varies by team cohesion. Health Serv Res 2014; 49 (1 Pt 2): 438-452
    CrossrefPubMedGoogle Scholar
  • 40 Feufel MA, Robinson FE, Shalin VL. The impact of medical record technologies on collaboration in emergency medicine. Int J Med Inform 2011; 80 (08) e85-e95
    CrossrefPubMedGoogle Scholar
  • 41 O'Malley AS, Grossman JM, Cohen GR, Kemper NM, Pham HH. Are electronic medical records helpful for care coordination? Experiences of physician practices. J Gen Intern Med 2010; 25 (03) 177-185
    CrossrefPubMedGoogle Scholar
  • 42 Romanow D, Rai A, Keil M. CPOE-enabled coordination: appropriation for deep structure use and impacts on patient outcomes. Manage Inf Syst Q 2018; 42 (01) 189-212
    CrossrefPubMedGoogle Scholar
  • 43 Varpio L, Schryer CF, Lingard L. Routine and adaptive expert strategies for resolving ICT mediated communication problems in the team setting. Med Educ 2009; 43 (07) 680-687
    CrossrefPubMedGoogle Scholar
  • 44 Watterson JL, Rodriguez HP, Aguilera A, Shortell SM. Ease of use of electronic health records and relational coordination among primary care team members. Health Care Manage Rev 2020; 45 (03) 267-275
    CrossrefPubMedGoogle Scholar
  • 45 Page MJ, McKenzie JE, Bossuyt PM. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372 (71) n71
    Google Scholar
  • 46 Sirriyeh R, Lawton R, Gardner P, Armitage G. Reviewing studies with diverse designs: the development and evaluation of a new tool. J Eval Clin Pract 2012; 18 (04) 746-752
    CrossrefPubMedGoogle Scholar
  • 47 Abraham J, Jaros J, Ihianle I, Kochendorfer K, Kannampallil T. Impact of EHR-based rounding tools on interactive communication: a prospective observational study. Int J Med Inform 2019; 129: 423-429
    CrossrefPubMedGoogle Scholar
  • 48 Hertzum M, Simonsen J. Positive effects of electronic patient records on three clinical activities. Int J Med Inform 2008; 77 (12) 809-817
    CrossrefPubMedGoogle Scholar
  • 49 Hyde E, Murphy B. Computerized clinical pathways (care plans): piloting a strategy to enhance quality patient care. Clin Nurse Spec 2012; 26 (05) 277-282
    CrossrefPubMedGoogle Scholar
  • 50 Morrison C, Jones M, Blackwell A, Vuylsteke A. Electronic patient record use during ward rounds: a qualitative study of interaction between medical staff. Crit Care 2008; 12 (06) R148
    CrossrefPubMedGoogle Scholar
  • 51 Rogers C. Improving processes to capture present-on-admission pressure ulcers. Adv Skin Wound Care 2013; 26 (12) 566-572 , quiz 573–574
    CrossrefPubMedGoogle Scholar
  • 52 Asan O, Holden RJ, Flynn KE, Murkowski K, Scanlon MC. Providers' assessment of a novel interactive health information technology in a pediatric intensive care unit. JAMIA Open 2018; 1 (01) 32-41
    CrossrefPubMedGoogle Scholar
  • 53 Ash JS, Gorman PN, Lavelle M. et al. Perceptions of physician order entry: results of a cross-site qualitative study. Methods Inf Med 2003; 42 (04) 313-323
    Article in Thieme ConnectPubMedGoogle Scholar
  • 54 Cheng DR, South M. Electronic task management system: a pediatric institution's experience. Appl Clin Inform 2020; 11 (05) 839-845
    Article in Thieme ConnectPubMedGoogle Scholar
  • 55 Dalal AK, Schnipper J, Massaro A. et al. A web-based and mobile patient-centered “microblog” messaging platform to improve care team communication in acute care. J Am Med Inform Assoc 2017; 24 (e1): e178-e184
    CrossrefPubMedGoogle Scholar
  • 56 Goldman J, Abramovich IA, Sadovy B, Murphy KJ, Rice K, Reeves S. The development and implementation of an electronic departmental note in a colposcopy clinic. Comput Inform Nurs 2012; 30 (02) 91-96
    CrossrefPubMedGoogle Scholar
  • 57 Lloyd S, Long K, Oshni Alvandi A. et al. A National Survey of EMR Usability: comparisons between medical and nursing professions in the hospital and primary care sectors in Australia and Finland. Int J Med Inform 2021; 154: 104535
    CrossrefPubMedGoogle Scholar
  • 58 Munoz DA, Bastian ND, Ventura M. A Workflow Assessment for a Pediatric Intensive Care Unit: A Mixed-Methods Approach. Paper presented at: IIE Annual Conference Proceedings; 2014: 2952-2961
    PubMedGoogle Scholar
  • 59 Nelson P, Bell AJ, Nathanson L, Sanchez LD, Fisher J, Anderson PD. Ethnographic analysis on the use of the electronic medical record for clinical handoff. Intern Emerg Med 2017; 12 (08) 1265-1272
    CrossrefPubMedGoogle Scholar
  • 60 Samal L, Dykes PC, Greenberg JO. et al. Care coordination gaps due to lack of interoperability in the United States: a qualitative study and literature review. BMC Health Serv Res 2016; 16: 143
    CrossrefPubMedGoogle Scholar
  • 61 Sidlow R, Katz-Sidlow RJ. Using a computerized sign-out system to improve physician-nurse communication. Jt Comm J Qual Patient Saf 2006; 32 (01) 32-36
    PubMedGoogle Scholar
  • 62 Ward MM, Vartak S, Loes JL. et al. CAH staff perceptions of a clinical information system implementation. Am J Manag Care 2012; 18 (05) 244-252
    PubMedGoogle Scholar
  • 63 Blijleven V, Koelemeijer K, Wetzels M, Jaspers M. Workarounds emerging from electronic health record system usage: consequences for patient safety, effectiveness of care, and efficiency of care. JMIR Human Factors 2017; 4 (04) e27
    CrossrefPubMedGoogle Scholar
  • 64 Sittig DF, Wright A, Ash J, Singh H. New unintended adverse consequences of electronic health records. Yearb Med Inform 2016; (01) 7-12
    PubMedGoogle Scholar
  • 65 Havens DS, Gittell JH, Vasey J. Impact of relational coordination on nurse job satisfaction, work engagement and burnout: achieving the quadruple aim. J Nurs Adm 2018; 48 (03) 132-140
    CrossrefPubMedGoogle Scholar
  • 66 Gittell JH. Relational Coordination: Guidelines for Theory, Measurement and Analysis. Waltham, MA: Brandeis University; 2011
    Google Scholar
  • 67 Goddard AF, Patel M. The changing face of medical professionalism and the impact of COVID-19. Lancet 2021; 397 (10278): 950-952
    CrossrefPubMedGoogle Scholar
  • 68 Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med 2014; 12 (06) 573-576
    CrossrefPubMedGoogle Scholar
  • 69 Sikka R, Morath JM, Leape L. The quadruple aim: care, health, cost and meaning in work. BMJ Qual Saf 2015; 24 (10) 608-610
    CrossrefPubMedGoogle Scholar
  • 70 Poon EG, Trent Rosenbloom S, Zheng K. Health information technology and clinician burnout: current understanding, emerging solutions, and future directions. J Am Med Inform Assoc 2021; 28 (05) 895-898
    CrossrefPubMedGoogle Scholar
  • 71 Smith CD, Balatbat C, Corbridge S. et al. Implementing Optimal Team-Based Care to Reduce Clinician Burnout. . NAM Perspectives. National Academy of Medicine; 2018
    Google Scholar
  • 72 Esmaeilzadeh P, Mirzaei T. Using electronic health records to mitigate workplace burnout among clinicians during the COVID-19 pandemic: field study in Iran. JMIR Med Inform 2021; 9 (06) e28497
    CrossrefPubMedGoogle Scholar
  • 73 Holzer KJ, Lou SS, Goss CW. et al. Impact of changes in EHR use during COVID-19 on physician trainee mental health. Appl Clin Inform 2021; 12 (03) 507-517
    Article in Thieme ConnectPubMedGoogle Scholar
  • 74 Chang BP, Cato KD, Cassai M, Breen L. Clinician burnout and its association with team based care in the Emergency Department. Am J Emerg Med 2019; 37 (11) 2113-2114
    CrossrefPubMedGoogle Scholar
  • 75 Song H, Ryan M, Tendulkar S. et al. Team dynamics, clinical work satisfaction, and patient care coordination between primary care providers: A mixed methods study. Health Care Manage Rev 2017; 42 (01) 28-41
    CrossrefPubMedGoogle Scholar
  • 76 Welp A, Meier LL, Manser T. The interplay between teamwork, clinicians' emotional exhaustion, and clinician-rated patient safety: a longitudinal study. Crit Care 2016; 20 (01) 110
    CrossrefPubMedGoogle Scholar
  • 77 Carter BL, Rogers M, Daly J, Zheng S, James PA. The potency of team-based care interventions for hypertension: a meta-analysis. Arch Intern Med 2009; 169 (19) 1748-1755
    CrossrefPubMedGoogle Scholar
  • 78 Berry JC, Davis JT, Bartman T. et al. Improved safety culture and teamwork climate are associated with decreases in patient harm and hospital mortality across a hospital system. J Patient Saf 2020; 16 (02) 130-136
    CrossrefPubMedGoogle Scholar
  • 79 Lyubovnikova J, West MA, Dawson JF, Carter MR. 24-Karat or fool's gold? Consequences of real team and co-acting group membership in healthcare organizations. Eur J Work Organ Psychol 2015; 24 (06) 929-950
    CrossrefPubMedGoogle Scholar
  • 80 Will KK, Johnson ML, Lamb G. Team-based care and patient satisfaction in the hospital setting: a systematic review. J Patient Cent Res Rev 2019; 6 (02) 158-171
    CrossrefPubMedGoogle Scholar
  • 81 Davis MJ, Luu BC, Raj S, Abu-Ghname A, Buchanan EP. Multidisciplinary care in surgery: are team-based interventions cost-effective?. Surgeon 2021; 19 (01) 49-60
    CrossrefPubMedGoogle Scholar
  • 82 Reeves S, Goldman J, Gilbert J. et al. A scoping review to improve conceptual clarity of interprofessional interventions. J Interprof Care 2011; 25 (03) 167-174
    CrossrefPubMedGoogle Scholar