Designing Health IT for Teamwork: A Human Factors Study of Hospital Bedside Rounds

Health information technology (IT) is implemented in various healthcare processes including multidisciplinary rounds (MDRs), which is an important form of collaborative work in patient care. Health IT that is used during MDRs should be designed to facilitate team interactions in a given context or work system. Through a macroergonomics (work system) perspective, this study uses direct observation method to examine and compare the rounding process and health IT use in three hospital services (contexts or work systems): hospitalist, medical critical care and surgical critical care. The first research question analyzes the following aspects of MDR: 1) characteristics of MDRs, 2) task performance and health IT use, and 3) role involvement and health IT use, across three services. Results show that MDRs in the hospitalist service have the shortest duration and the smallest team. The medical critical care service has the largest team and the surgical critical care service is the most frequent user of computers. The hospitalist teams introduce team members to patients/family and ask patients/family for questions more frequently compared to the two critical care services. Hospitalist teams do not use computers. In the two critical care services, health IT is often used for tasks of "update on overnight events and patient status" and "discuss assessment and summarize plan". Pharmacists and residents use health IT very often, while attendings, fellows and nurses use do not use health IT often during MDRs.;The second research question focuses on occurrences when multiple team members use the same computer simultaneously: what they use the computer for, who is involved, and when these occurrences happen. We identified a total of 111 occurrences of multi-users of health IT for 99 patient rounding sessions. The majority of these occurrences happened when team members discuss assessment and summarize for the day/stay. Team members use the same computer simultaneously throughout the entire patient rounding session, but more frequently towards the end of the rounding session. Computers are used for five purposes: 1) review and discuss notes and orders; 2) review and discuss laboratory results and H&P; 3) review and discuss medications; 4) review and discuss images; and 5) help others using EHR. Eighty-one percent of the occurrences involve two users. The rest of occurrences involve three or more than three users. Attendings and residents are involved in the occurrences of multiple-users the most frequently.;Based on these results, we provide a list of health IT design recommendations and suggest that health IT designers and implementers consider the specific MDR context in which health IT will be used so that team interactions are supported and users' information needs are met.