An exploration of the impact of computerized patient documentation on clinical collaboration

Purpose: The purpose of this study was to explore the experience of experienced users of computerized patient documentation for the purpose of collaboration and coordination. A secondary analysis of qualitative data using Clark's theoretical framework of communication was conducted with the goal of bringing research findings into design. Methods: Physicians, nurses and administrative staff volunteered to participate in focus groups at 4 VA sites. Each focus group lasted 1.5 h and targeted experience and issues with using computerized documentation. All focus groups were audio-taped and transcribed and submitted to extensive qualitative analysis using ATLAS, iterative identification of concepts and categories. The communication category was targeted for secondary theoretical analysis in order to deepen understanding of the findings. Clark's theory of communication, joint action and common ground heuristics was used to analyze concepts. Results: Key concepts included: (1) CPD has changed the way that narrative documentation is used in clinical settings to include more communication functions, strategies to establish joint action in both negative and positive ways; (2) functionality added to CPD to increase the efficiency of input may have increased the efficiency of CPD to support shared situation models, joint and action and the establishment of common ground; (3) new usage of CPD may increase tensions between clinical and administrative roles as the role of narrative is re-defined. Conclusions: This study demonstrates how socio-technical systems co-evolve to support essential human function of coordination and collaboration. Users adapted the system in unique and useful ways that provide insight to future development. Published by Elsevier Ireland Ltd