The Effect of Health Information Technology on Healthcare Provider Communication

Use of technology in healthcare has moved from traditional face-to-face time between nurses and physicians to communication through technology such as the electronic health record, computerized provider order entry, email, and pagers. While this change may improve the efficiency of communication, it increases message ambiguity. Poor communication between physicians and nurses is a known cause of adverse events and a major root cause of all sentinel events. It is therefore critically important to better understand how communication technology is used in healthcare.

This research studied how technologies facilitate or hinder communication between nurses and physicians with the ultimate goal of identifying optimal ways to support effective communication.

The specific aims of the research were as follows:

• Identify the range of communication technologies used in a national sample of medical-surgical acute care units. 
• Describe communication practices and work relationships that may be influenced by communication technologies in these same settings. 
• Explore how differences in communication technologies, communication practices, and work relationships between physicians and nurses influence communication. 

This research was conducted in medical-surgical units, where most inpatient care is provided, but where little is known about how providers communicate with one another. A quantitative survey was sent to 105 hospitals that were members of the National Nursing Practice Network (NNPN), a consortium of hospitals dedicated to evidence-based nursing practice. The survey consisted of seven sections with the following topics: overall health information technology adoption, computer hardware, use of computers by physicians and nurses, infrastructure for electronic communication, use of electronic communication technologies, nonelectronic ways of communicating, and demographics. From the 74 hospitals that completed the survey, 8 were chosen for followup telephone interviews, representing a variety of technology and communication practices. Two-week site visits were made to four of the eight hospitals to conduct observation, shadowing of clinicians, and focus groups to gather information on communication in real-world situations.

Relationships and familiarity of nurses and physicians with one another determined technology use, regardless of the technology available. When relationships between physicians and nurses are good, both seek out face-to-face conversations, but otherwise resort to technologies such as pagers and texting to avoid one another. This avoidance leads to asynchronous communication and irregular information exchange, with implications for patient safety. Additional key findings were that physician and nurse expectations and preferences for communication methods were different, nurses sometimes manipulated communication to get certain responses, and a lack of trust in and responsiveness of physicians could pose a risk to patient safety. The researchers concluded: 1) synchronous communication and information exchange are beneficial, as they provide the opportunity for immediate clarification; 2) access to the same technology facilitates communication; and 3) improvement of work relationships between nurses and physicians is key to improving communication.