Optimizing clinical documentation in virtual hospitals: a task-technology fit perspective

Virtual hospitals differ from brick-and-mortar hospitals across many elements of the socio-technical work system, particularly their complete reliance on digital tools for communication and care coordination. It is currently unclear whether existing initiatives to improve clinical documentation in brick-and-mortar hospitals are fit for purpose in virtual hospital settings. This study aimed to examine the documentation experiences of clinicians when using technologies to support care delivery in a virtual hospital and to identify fit-for-purpose initiatives to optimize documentation processes.

We performed focus groups and a co-design workshop with 28 nursing and medical staff at a virtual hospital. Focus group data were first analyzed inductively, and later deductively mapped to the task-technology fit framework. Field notes from the workshop were recorded, digitized and analyzed thematically.

We identified the unique characteristics of tasks and technologies used in a virtual hospital and found problems with data findability and difficulty in using multiple technologies concurrently, arising from the technology-mediated nature of virtual care, which led to performance impacts on clinicians (eg, inefficiency, duplication of work) and potential impacts on patients (limits time for patient care). Also, we identified opportunities where technologies could be used to streamline documentation (eg, automatic generation of handover notes, reduction of free-text entries, use of AI scribes), opportunities for streamlining documentation tasks (ie, matching documentation requirement to nature of encounter), and strategies for optimizing the escalation process in virtual hospitals (ie, removing extra escalation layers and aligning more closely with escalation practices in brick-and-mortar hospitals).

Whilst tasks and technologies used for care delivery differ between virtual and traditional hospitals, documentation problems and impacts are fairly consistent across settings. However, the virtual environment amplifies these challenges due to clinicians' dependence on multiple digital systems. We identified a clear need for functionality that supports a team-based approach to virtual care delivery and a need for policy review, escalation process review and clinical task re-design prior to incorporating additional technologies to minimize documentation burden (eg, AI scribes) in virtual settings.