title: It's not about pager replacement: an in-depth look at the interprofessional nature of communication in healthcare.
abstract: BACKGROUND
  Institutions have tried to replace the use of numeric pagers for clinical communication by implementing health information technology (HIT) solutions. However, failing to account for the sociotechnical aspects of HIT or the interplay of technology with existing clinical workflow, culture, and social interactions may create other unintended consequences.
  
  
  OBJECTIVE
  To evaluate a Web-based messaging system that allows asynchronous communication between health providers and identify the unintended consequences associated with implementing such technology.
  
  
  METHODS
  Intervention-a Web-based messaging system at the University Health Network to replace numeric paging practices in May 2010. The system facilitated clinical communication on the medical wards for coordinating patient care. Study design-pre-post mixed methods utilizing both quantitative and qualitative measures.
  
  
  METHODS
  Five residents, 8 nurses, 2 pharmacists, and 2 social workers were interviewed. Pre-post interruption-15 residents from 5 clinical teams in both periods.
  
  
  METHODS
  The study compared the type of messages sent to physicians before and after implementation of the Web-based messaging system; a constant comparative analysis of semistructured interviews was used to generate key themes related to unintended consequences.
  
  
  RESULTS
  Interruptions increased 233%, from 3 pages received per resident per day pre-implementation to 10 messages received per resident per day post-implementation. Key themes relating to unintended consequences that emerged from the interviews included increase in interruptions, accountability, and tactics to improve personal productivity.
  
  
  CONCLUSIONS
  Meaningful improvements in clinical communication can occur but require more than just replacing pagers. Introducing HIT without addressing the sociotechnical aspects of HIT that underlie clinical communication can lead to unintended consequences.
authors: Centre for Innovation in Complex Care, University Health Network, Toronto, Canada. sherman.quan@uhn.ca
authors: Sherman D
authors: SD
authors: Quan
authors: Robert C
authors: RC
authors: Wu
authors: Peter G
authors: PG
authors: Rossos
authors: Teri
authors: T
authors: Arany
authors: Silvi
authors: S
authors: Groe
authors: Dante
authors: D
authors: Morra
authors: Brian M
authors: BM
authors: Wong
authors: Rodrigo
authors: R
authors: Cavalcanti
authors: William
authors: W
authors: Coke
authors: Francis Y
authors: FY
authors: Lau
mesh_terms: D040421:Cell Phone / Q000592:standards*; D003695:Delivery of Health Care / Q000379:methods / Q000592:standards*; D006747:Hospital Communication Systems / Q000592:standards*; D006801:Humans; D033183:Interdisciplinary Communication; D007400:Interprofessional Relations; D005791:Patient Care / Q000379:methods / Q000592:standards