Researchers: Anat Drach-Zahavy ¹, Maayan Agmon ¹, Nail Bisharat²

Background: To improve patient quality of care (QoC) in the routine of medical wards, two distinct, yet potentially interconnected strategies have been proposed: Electronic health records (EHR) and multidisciplinary teams. However, the connections among EHR, teamwork, and QoC are yet to be determined.

Objectives: To examine whether the association between the quality of information (QoI) entered into the EHR and QoC is mediated by the inter-professional team processes (team communication, coordination, and commitment).

Method: Data was collected using mixed (qualitative and quantitative methods) design. Quantitative– the unit of analysis was the patient and members of the multi-professional team (physicians, nurses, para-medical professionals) associated with his/her care during a specific shift. Multi-source (patients/relatives and providers), multi-method (questionnaires, data retrieved from EHR) data was collected from 188 patients and 419 care providers. Main analyzes were conducted on a sub sample, including 85 patients' data and 135 care providers (at least two completed questionnaires from each of 2-3 care providers). This restricted sample was based on power calculation and a sensitivity analysis using the larger sample of 188 patients (findings from both analyses are described). Qualitative– 42 professionals participated in focus groups and in-depth semi-structured interviews. Main themes are described.

Findings: Professionals perceived (a) the EHR as contributing to the team's processes, especially when the system is relevant to their routine work, and the interface is suitable to their needs; (b) the QoI inserted into the EHR was positively linked to their quality of team's processes: communication, coordination and commitment. The communication mediated the relationships between QoI and team effectiveness. However, QoI was directly associated with the objective measures of QoC: glycemic control during hospitalization; ADL and mobility post discharge. These finding are partially supported by the quantitative findings that demonstrated more complicated picture regarding the contribution of EHR to team work.

Conclusions: These findings probably mirror two challenges in healthcare organizations, namely the difficulty to collaborate in teams and the limitations of the EHR to advance effective work processes. Policy maker should involve medical team in designing the EHR ststem while considering the role of teamwork.

Research end date: 12/2019