Tensions associated with the use of electronic knowledge resources within clinical decision-making processes: a...

Area of Science:

• Medical Informatics
• Human-Computer Interaction
• Clinical Decision Support

Background:

• Health professionals increasingly rely on electronic knowledge resources (EKRs) for clinical decision-making.
• Limited research exists on the tensions that may arise from EKR use in clinical settings.

Purpose of the Study:

• To explore user-computer, social, and organizational tensions associated with EKR use.
• To understand how these tensions impact clinical decision-making.

Main Methods:

• A multiple case study design was employed, focusing on Family Medicine residents.
• Data collection involved interviews with residents regarding their use of EKRs (InfoRetriever on PDA) during patient encounters.
• Qualitative analysis of interview transcripts identified and categorized types of EKR-related tensions.

Main Results:

• Twenty-five cases of tension were identified, categorized into user-computer (N=16), social (N=7), and organizational (N=3) tensions.
• User-computer tension involved difficulties between the resident and the EKR.
• Social tensions arose between residents and supervisors, other professionals, or patients.
• Organizational tensions stemmed from system or policy constraints.

Conclusions:

• EKR implementation in clinical decision-making can lead to negative consequences due to user-computer, social, and organizational tensions.
• These identified tensions are interconnected and can occur simultaneously.
• Recognizing and managing these EKR-related tensions is crucial for successful integration into clinical practice.