title: An Ethnographic Study of Health Information Technology Use in Three Intensive Care Units.
abstract: To identify the impact of a full suite of health information technology (HIT) on the relationships that support safety and quality among intensive care unit (ICU) clinicians.
  
  
  
  A year-long comparative ethnographic study of three academic ICUs was carried out. A total of 446 hours of observational data was collected in the form of field notes. A subset of these observations-134 hours-was devoted to job-shadowing individual clinicians and conducting a time study of their HIT usage.
  
  
  
  Significant variation in HIT implementation rates and usage was noted. Average HIT use on the two "high-use" ICUs was 49 percent. On the "low-use" ICU, it was 10 percent. Clinicians on the high-use ICUs experienced "silo" effects with potential safety and quality implications. HIT work was associated with spatial, data, and social silos that separated ICU clinicians from one another and their patients. Situational awareness, communication, and patient satisfaction were negatively affected by this siloing.
  
  
  
  HIT has the potential to accentuate social and professional divisions as clinical communications shift from being in-person to electronically mediated. Socio-technically informed usability testing is recommended for those hospitals that have yet to implement HIT. For those hospitals already implementing HIT, we suggest rapid, locally driven qualitative assessments focused on developing solutions to identified gaps between HIT usage patterns and organizational quality goals.
authors.affiliation: University of Calgary School of Public Policy, Calgary, AB, Canada.
authors.forename: Myles
authors.initials: M
authors.lastname: Leslie
authors.affiliation: Leslie Dan Faculty of Pharmacy and the Department of Anesthesia and the Wilson Centre, University of Toronto, Toronto, ON, Canada.
authors.forename: Elise
authors.initials: E
authors.lastname: Paradis
authors.affiliation: Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gropper
authors.affiliation: Department of Innovation in Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Simon
authors.initials: S
authors.lastname: Kitto
authors.affiliation: Centre for Health and Social Care Research, St George's Hospital, Kingston University & St George's, London, UK.
authors.forename: Scott
authors.initials: S
authors.lastname: Reeves
authors.affiliation: Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD.|Departments of Anesthesiology and Critical Care Medicine, Surgery, and Health Policy and Management, Johns Hopkins University, Baltimore, MD.
authors.forename: Peter
authors.initials: P
authors.lastname: Pronovost
mesh_terms: D000884:Anthropology, Cultural; D004059:Diffusion of Innovation; D006801:Humans; D007362:Intensive Care Units; D033183:Interdisciplinary Communication; D008490:Medical Informatics; D061214:Patient Safety; D011787:Quality of Health Care
keywords: Health information technology; ethnography; health care teamwork and communications