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Table 2 Overview of facilitating and constraining influences of the EHR’s inscribed collaborative affordances

From: The influence of electronic health record use on collaboration among medical specialties

Inscribed collaborative affordances: Users recognized that the EHRfacilitates... Users recognized that the EHR
constrains ...
Portability … accessibility of patient data, independent of location and medical context. … digital sharing of patient data with health providers outside the hospital.
… integration of patient data from different specialties, resulting in a comprehensive overview. ...mutual understanding of patient data because of specialty- and discipline-specific user-interfaces.
Co-located access … professionals viewing the same data from different locations. … modifying health records and entering orders simultaneously (by different professionals).
… a comprehensive overview during multidisciplinary meetings because of a lack of desktops.
Shared overview … integration and availability of patient information, avoids multiple data sources and handwritten notes. … cognitively processing the overview. Information overload is experienced, due to the large number of notes and patient information not being presented in a chronological order.
… once-only registration (at the source) and full registration of activities through orders. … generating a cross-specialty overview since patient data are specialty- and department- specific. Departments and specialties use medical history and problem lists in different ways, leading to incomplete files.
Mutual awareness … hospital-wide working processes. … obtaining an easy-to-use overview due to information overload and patient information not being presented in a chronological order.
… notification of results, quick updates. … a shared awareness because patient data models are specialty- and department- specific.
Messaging … discussing patients with other specialties without needing to refer them to the other specialties. … face-to-face communication. The reduced need for face-to-face communication saves time but is experienced as reducing the collective responsibility for a smooth workflow.
… the replacement of other messaging systems. … an easy overview due to message overload.
...uniform forms of communication.
Orchestrating … efficient and shared working processes. … flexible task distribution. Strict authorizations constrain flexible, multidisciplinary task distribution.
… the systematic registration of results. … process efficiency due to a strict focus on orders.
… ad hoc, diverse forms of collaboration. The EHR system enforces system-supported forms of collaboration. Some multidisciplinary consultations are not supported by the EHR.