Int J Med Inform - The impact of medical record technologies on collaboration in emergency medicine.

Tópicos

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Resumo

RPOSE: Electronic medical records (EMR) promise potential benefits for the practice of medical care. However, individual technologies such as EMR must interact with the work system as a whole - including people, technology and work practices - to enable or hinder the coordination of dynamic work demands. Based on this extended perspective, we address in this paper how support technologies (should) impact the coordination of work across multiple agents, controlling a dynamic domain with multiple, interacting processes. The technology we address is the medical record and the dynamic domain is emergency medicine as it is practiced in the U.S.METHOD: We performed 500 hours of naturalistic observations of physicians in two different hospital emergency departments in the Midwestern U.S differing in their reliance on paper or electronic medical records.RESULTS AND CONCLUSIONS: An analysis of work practice across the two hospitals revealed the role of medical records in facilitating or hindering the coordination of time sensitive and context dependent distributed work, as well as the specific influence of EMR. Recognizing that work practice compensates for the limitations of technology, we suggest four requirements for the design of EMR to promote workplace efficiency: facilitation of locally customized data presentations; support for integration of hitherto fragmented record systems and data formats; support for effective multi-user coordination of control tasks; and guidance for standardizing a level of detail in planning and documenting care.

Resumo Limpo

rpose electron medic record emr promis potenti benefit practic medic care howev individu technolog emr must interact work system whole includ peopl technolog work practic enabl hinder coordin dynam work demand base extend perspect address paper support technolog impact coordin work across multipl agent control dynam domain multipl interact process technolog address medic record dynam domain emerg medicin practic usmethod perform hour naturalist observ physician two differ hospit emerg depart midwestern us differ relianc paper electron medic recordsresult conclus analysi work practic across two hospit reveal role medic record facilit hinder coordin time sensit context depend distribut work well specif influenc emr recogn work practic compens limit technolog suggest four requir design emr promot workplac effici facilit local custom data present support integr hitherto fragment record system data format support effect multius coordin control task guidanc standard level detail plan document care

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