Technology Readiness through Collaborative Reflection: A Qualitative Case Study of an Under-resourced Nurse-Managed Clinic

This paper reports how a nurse-managed primary care clinic (NMPCC) prepared for the implementation of an Electronic Health Record (EHR) system with limited resources. EHR adoption is a complex task that requires not only implementing a system but also an integration of the system into the existing sociotechnical environments. In this study, we identified three stages of the process improvement meetings conducted at the clinic: (1) understanding routines, roles, and practices, (2) identifying problems and deficiencies, and (3) iterating interventions by optimizing resources through reconfiguring artifacts and work practices. Importantly, we found the staff jointly reflecting on one another's experiences and practices by making sense of the collaborative work. We regarded this sense-making process as collaborative reflection, and argued that it enhanced technology readiness of the NMPCC through creating a more technology-compatible and collaborative sociotechnical environment for the impending EHR implementation.

[1]  Allison Druin,et al.  Single display groupware: a model for co-present collaboration , 1999, CHI '99.

[2]  M. Carpendale,et al.  Evaluating the deployment of a mobile technology in a hospital ward , 2008, CSCW.

[3]  Marc Berg,et al.  Viewpoint Paper: Some Unintended Consequences of Information Technology in Health Care: The Nature of Patient Care Information System-related Errors , 2003, J. Am. Medical Informatics Assoc..

[4]  Claus Bossen,et al.  Mobility Work: The Spatial Dimension of Collaboration at a Hospital , 2005, Computer Supported Cooperative Work (CSCW).

[5]  Gregory M. Nielson,et al.  Visualizing functions over a sphere , 1990, IEEE Computer Graphics and Applications.

[6]  D. Boud,et al.  Reflection, turning experience into learning , 1985 .

[7]  S. Høyrup.  Reflection as a core process in organisational learning , 2004 .

[8]  D. Simpson,et al.  Assessing organizational readiness for change. , 2002, Journal of substance abuse treatment.

[9]  Andrew Hamilton,et al.  A partnership model for implementing electronic health records in resource-limited primary care settings: experiences from two nurse-managed health centers , 2011, J. Am. Medical Informatics Assoc..

[10]  Margreet B. Michel-Verkerke,et al.  Evaluation of an Electronic Patient Record in a Nursing Home: One Size Fits All? , 2012, 2012 45th Hawaii International Conference on System Sciences.

[11]  Martin Dyke,et al.  The role of the ‘Other’ in reflection, knowledge formation and action in a late modernity , 2006 .

[12]  Y. Han,et al.  Unexpected Increased Mortality After Implementation of a Commercially Sold Computerized Physician Order Entry System , 2005, Pediatrics.

[13]  Bridget M Kuehn.  IT vulnerabilities highlighted by errors, malfunctions at veterans' medical centers. , 2009, JAMA.

[14]  David N Gans.  Off to a slow start... , 2005, MGMA connexion.

[15]  John Doucette,et al.  Adopting electronic medical records in primary care: Lessons learned from health information systems implementation experience in seven countries , 2009, Int. J. Medical Informatics.

[16]  P. Shekelle,et al.  Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care , 2006, Annals of Internal Medicine.

[17]  Chun-Chieh Yang,et al.  Assessing and managing employee readiness for embracing e-business , 2008, SIGMIS CPR '08.

[18]  Paola D. Miralles,et al.  Evidence of an emerging digital divide among hospitals that care for the poor. , 2009, Health affairs.

[19]  A. Boonstra,et al.  Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions , 2010, BMC health services research.

[20]  K. Lewin.  Field theory in social science , 1951 .

[21]  Rob Procter,et al.  Making a Case in Medical Work: Implications for the Electronic Medical Record , 2003, Computer Supported Cooperative Work (CSCW).

[22]  Monika Sester,et al.  Visualization in an early stage of the problem-solving process in GIS , 2000 .

[23]  Sun Young Park,et al.  Adaptation as design: learning from an EMR deployment study , 2012, CHI.

[24]  Michele Richardson,et al.  Nurse‐managed health centers: Safety‐net care through advanced nursing practice , 2012, Journal of the American Academy of Nurse Practitioners.

[25]  Jesse C. Crosson,et al.  Electronic Medical Records and Diabetes Quality of Care: Results From a Sample of Family Medicine Practices , 2007, The Annals of Family Medicine.

[26]  E. Hing,et al.  Use of computerized clinical support systems in medical settings: United States, 2001-03. , 2005, Advance data.

[27]  David C Classen,et al.  Understanding hospital readiness for computerized physician order entry. , 2003, Joint Commission journal on quality and safety.

[28]  John Walker.  Implementation , 2001 .

[29]  Rob F. Poell,et al.  Facing Up to the Learning Organisation Challenge: Key Issues from a European Perspective. Volume I. CEDEFOP Reference Series. , 2003 .

[30]  Rita Snyder-Halpern,et al.  Indicators of organizational readiness for clinical information technology/systems innovation: a Delphi study , 2001, Int. J. Medical Informatics.

[31]  Y. Han,et al.  Han YY, Carcillo JA, Venkataraman ST, Clark RS, Watson RS, Nguyen TC, Bayir H, Orr RA. Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system. Pediatrics , 2011 .

[32]  Anne F. Kittler,et al.  A cost-benefit analysis of electronic medical records in primary care. , 2003, The American journal of medicine.

[33]  Thomas Herrmann,et al.  Collaborative reflection at work: supporting informal learning at a healthcare workplace , 2012, GROUP.

[34]  Sun Young Park,et al.  Loosely formed patient care teams: communication challenges and technology design , 2012, CSCW.

[35]  Gordon B. Davis,et al.  User Acceptance of Information Technology: Toward a Unified View , 2003, MIS Q..

[36]  Yunan Chen,et al.  A lessons learned system in healthcare IT implementation. , 2007, AMIA ... Annual Symposium proceedings. AMIA Symposium.