November 16, 2017

N&AHP

EJRC ARTICLE REVIEW

Is high use health information technology having a negative impact on the ICU team and patient care?

 

Over recent years, Health Information Technology (HIT) – a broad concept encompassing all electronic applications to store, share and analyse health data, has become a major component in most Intensive Care Units, often as a result of national and international recommendations. Its first objective is to improve “quality, safety and efficiency of care”(1). Nevertheless, a number of concerns have arisen regarding some unintended consequences on team communication and global safety.

This article explores a yearlong comparative study of three academic ICUs, which attempted to measure the impact of high use health information technology on team relationships (2). Including 446 hours of observational data, and a subset of 134 hours job-shadowing 32 nurses and 15 junior doctors on the use of HIT; observations were clarified with informal and formal interviews with staff and family members. Usage was defined as time spent using any HIT application or data source.

Although they noted significant variations in implementation and usage throughout the three units, in the two ICUs where HIT was strongly developed, clinicians spend 49% of their time on a computer. Clinicians tended to isolate themselves in “professional silos” to complete their computer work, reducing contact between doctors and nurses; each category focused on their specific tasks, writing data that none of the other professions would read. Results showed a marked reduction on clinicians’ global, situational awareness and on communication that could support team coordination; and patients and families expressed concern in observing that clinicians were often “focused on the iPatient” rather than on the person lying in the bed.

One of the main interesting points of this paper is that HIT is not observed only as a charting or prescribing application, but as a combination of computer work that “shapes clinical relationships”. Therefore, the results reflect how front-line clinicians (nurses and junior doctors) interact with colleagues, patients and the HIT infrastructure. A socio-technical approach shows also that HIT implementation may exacerbate and reveal previous team cohesion issues. Nevertheless, the study did not include measures of patients’ outcomes or experiences of care, and the impact of HIT on these issues is for the moment only an extrapolation of how the reduction on team communication and clinicians awareness can play a role on patients’ safety. Further research on these aspects is still needed.

As noted in the article, the tide has been cast, and in the future there will be no return to paper, thus, moving forward, thoughtful HIT implementation must take into consideration how it will be integrated in the unit’s environment to avoid the “siloing experience” observed in this study. The challenge will be to recreate physical and social spaces to enhance communication and shared team interaction that will have a more positive impact on patient care and safety.

Article review prepared and submitted by Silvia Calvino Günther, member of N&AHP Committee, ESICM.


References

  1. Blumenthal, D. 210 “Launching HITECH.” New England Journal of Medicine 362 (5): 382-5. Doi: 10.1056/NEJMp0912825.
  2. Leslie M, Paradis E, Gropper MA, Kitto S, Reeves S, Pronovost P. An Ethnographic Study of Health Information Technology Use in Three Intensive Care Units. Health Services Research (2017) Aug; 52(4): 1330-1348. doi: 10.1111/1475-6773.12466.

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