title: Mapping communication spaces: The development and use of a tool for analyzing the impact of EHRs on interprofessional collaborative practice.
abstract: Members of the healthcare team must access and share patient information to coordinate interprofessional collaborative practice (ICP). Although some evidence suggests that electronic health records (EHRs) contribute to in-team communication breakdowns, EHRs are still widely hailed as tools that support ICP. If EHRs are expected to promote ICP, researchers must be able to longitudinally study the impact of EHRs on ICP across communication types, users, and physical locations.
  
  
  
  This paper presents a data collection and analysis tool, named the Map of the Clinical Interprofessional Communication Spaces (MCICS), which supports examining how EHRs impact ICP over time, and across communication types, users, and physical locations.
  
  
  
  The tool's development evolved during a large prospective longitudinal study conducted at a Canadian pediatric academic tertiary-care hospital. This two-phased study [i.e., pre-implementation (phase 1) and post implementation (phase 2)] of an EHR employed a constructivist grounded theory approach and triangulated data collection strategies (i.e., non-participant observations, interviews, think-alouds, and document analysis). The MCICS was created through a five-step process: (i) preliminary structural development based on the use of the paper-based chart (phase 1); (ii) confirmatory review and modification process (phase 1); (iii) ongoing data collection and analysis facilitated by the map (phase 1); (iv) data collection and modification of map based on impact of EHR (phase 2); and (v) confirmatory review and modification process (phase 2).
  
  
  
  Creating and using the MCICS enabled our research team to locate, observe, and analyze the impact of the EHR on ICP, (a) across oral, electronic, and paper communications, (b) through a patient's passage across different units in the hospital, (c) across the duration of the patient's stay in hospital, and (d) across multiple healthcare providers. By using the MCICS, we captured a comprehensive, detailed picture of the clinical milieu in which the EHR was implemented, and of the intended and unintended consequences of the EHR's deployment. The map supported our observations and analysis of ICP communication spaces, and of the role of the patient chart in these spaces.
  
  
  
  If EHRs are expected to help resolve ICP challenges, it is important that researchers be able to longitudinally assess the impact of EHRs on ICP across multiple modes of communication, users, and physical locations. Mapping the clinical communication spaces can help EHR designers, clinicians, educators and researchers understand these spaces, appreciate their complexity, and navigate their way towards effective use of EHRs as means for supporting ICP. We propose that the MCICS can be used "as is" in other academic tertiary-care pediatric hospitals, and can be tailored for use in other healthcare institutions.
authors.affiliation: Nursing Research, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, Canada; School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, Canada. Electronic address: rashotte@cheo.on.ca.
authors.forename: Judy
authors.initials: J
authors.lastname: Rashotte
authors.affiliation: Academy of Innovation in Medical Education, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, Canada; Department of Medicine, Uniformed Services for the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, USA. Electronic address: lara.varpio@usuhs.edu.
authors.forename: Lara
authors.initials: L
authors.lastname: Varpio
authors.affiliation: Academy of Innovation in Medical Education, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, Canada. Electronic address: Kathy.day@uottawa.ca.
authors.forename: Kathy
authors.initials: K
authors.lastname: Day
authors.affiliation: Telfer School of Management, University of Ottawa, 55 Laurier Avenue East, Ottawa, Ontario, Canada. Electronic address: Kuziemsky@telfer.uottawa.ca.
authors.forename: Craig
authors.initials: C
authors.lastname: Kuziemsky
authors.affiliation: Department of Psychology, Carleton University, Loeb B550, 1125 Colonel By Drive, Ottawa, Ontario, Canada. Electronic address: Avi_Parush@carleton.ca.
authors.forename: Avi
authors.initials: A
authors.lastname: Parush
authors.affiliation: Nursing & Patient Services, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, Canada. Electronic address: pelliottmiller@cna-aiic.ca.
authors.forename: Pat
authors.initials: P
authors.lastname: Elliott-Miller
authors.affiliation: Department of Pediatrics, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, Canada. Electronic address: king@cheo.on.ca.
authors.forename: James W
authors.initials: JW
authors.lastname: King
authors.affiliation: Information Technology Services, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, Canada. Electronic address: tyson.roffey@hds.com.
authors.forename: Tyson
authors.initials: T
authors.lastname: Roffey
mesh_terms: D002170:Canada; D003142:Communication; D003299:Cooperative Behavior; D003625:Data Collection; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D006801:Humans; D033181:Information Dissemination; D007400:Interprofessional Relations; D008137:Longitudinal Studies; D010347:Patient Care Planning; D010348:Patient Care Team / Q000458:organization & administration*; D011446:Prospective Studies
keywords: Communication spaces; Electronic health record; Grounded theory; Interprofessional collaboration practice; Mapping tool