The impact of medical record technologies on collaboration in emergency medicine

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.

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.

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.