title: Tensions associated with the use of electronic knowledge resources within clinical decision-making processes: a multiple case study.
abstract: CONTENT AND OBJECTIVE: Health professionals now routinely use electronic knowledge resources (EKRs). Few studies have considered EKR-related tensions which may arise in a clinical decision-making context. The present study aims to explore three types of tension: (1) user-computer tension, (2) social tensions, and (3) organizational tensions (constraints associated with organizational routines and health policies).
  We conducted a multiple case study, examining Family Medicine residents' searches for information in everyday life. Cases were defined as critical searches for information among 17 first year family medicine residents using InfoRetriever 2003/2004 on a PDA over 1.5 months at McGill University. InfoRetriever-derived information was used within a resident-patient decision-making context in 84 of 156 cases. For each case, residents were interviewed, and extracts of interview transcripts were assigned to themes using specialized software (presence of tension; type of tension). Further computer-assisted lexical-semantic analysis was performed on transcripts. Authors reached consensus on assignments.
  
  
  RESULTS
  Twenty-five cases with tension were identified (one case had two types of tension), and illustrate the above mentioned types of tensions: (T1) tension between the resident and InfoRetriever (N=16); (T2) InfoRetriever-related tension between the resident and other social actors, specifically supervisors, other health care professionals and patients (N=7); (T3) InfoRetriever-related tension between the resident and the health organization/system (N=3).
  
  
  CONCLUSIONS
  Results suggest EKR usage in a clinical decision-making context may have negative consequences when three types of tension arise in a clinical decision-making context. Illustrated types of tension are interrelated and not mutually exclusive. Awareness of EKR-related tensions may help clinicians to integrate EKRs in practice.
authors.affiliation: Information Technology Primary Care Research Group, McGill University, 517 Pine Avenue West, Montreal, QC H2W1S4, Canada.
authors.forename: N
authors.initials: N
authors.lastname: Mysore
authors.forename: P
authors.initials: P
authors.lastname: Pluye
authors.forename: R M
authors.initials: RM
authors.lastname: Grad
authors.forename: J
authors.initials: J
authors.lastname: Johnson-Lafleur
mesh_terms: D015331:Cohort Studies; D003657:Decision Making; D008490:Medical Informatics; D010818:Practice Patterns, Physicians'; D011792:Quebec