Electronic communication across organizational borders in healthcare: an empirical study

Abstract

This empirical study of the national message exchange system is aimed to serve as a partial evaluation within a local context, based on user experiences. A qualitative method based on semi-structured, open-ended interviews with clinical system users at the University Hospital of Northern-Norway and in the healthcare service of the Municipality of Tromsø, combined with informal meetings with project members and a literature review, serves as basis for the data collection. Hospital users described message use as additional work tasks, and as a rule had to rely on several methods of communication to ensure a safe and robust transfer of clinical information across health levels. The reasons for this appeared to be the need for more synchronous communication and a divide between administrative and clinical information handling in the municipalities. Message structure was in many cases conceived as confusing, and there seemed to be a lack of a proper training strategy for system use. In communication between municipal healthcare and GPs, the system was experienced as time saving and convenient due to the way it supported the asynchronous work practices. We argue that an on-going, thorough evaluation during the implementation process could have supported the work of mapping unintended consequences and dealing with them. We have identified specific aspects that we believe could have contributed to this, such as closer follow-up and monitoring of smaller municipalities, a more thorough strategy for user education, and message notification in the hospital’s EPR. However, the gap between intended use and existing work practices seems too wide to be bridged by these measures. We argue that the EME system matches poorly with existing local practices in the hospital especially, and that local practices should have been taken into consideration before implementing a system on such a large scale. It is obvious that there has been a lack of user perspectives in the evaluation of the EME system up to this point, and our thesis must be seen as a contribution towards a more comprehensive system evaluation.