Multi-disciplinary collaboration during ward rounds: embodied aspects of electronic medical record usage.

PURPOSE: Hospital medicine necessitates that practitioners from many disciplines collaborate to care for patients with complex illnesses. Much emphasis is placed on multi-disciplinary interaction during the ward round to achieve collaboration, but it can still be difficult to attain. This paper looks at how electronic medical records affect multi-disciplinary collaboration during ward rounds. METHODS: We take an embodied approach, with a specific focus on the spatial and postural patterning of bodies in space. Using F-formation system theory as an analytical starting point, we compare the non-verbal interaction systems that support multi-disciplinary interaction during usage of a paper medical record and an electronic medical record at two points after deployment. RESULTS: We show that the paper medical record supports a nuanced non-verbal interaction system which is used to negotiate the ward round interaction and facilitate multi-disciplinary communication. We also illustrated how the electronic medical record initially fails to support a similar non-verbal interaction system, but with some adjustments over time, the ward round team re-establishes a functioning non-verbal interaction system and with it, multi-disciplinary communication. CONCLUSIONS: We conclude with a discussion on the effects of electronic medical records on multi-disciplinary interaction and suggest a number of implications for their design: including, considering the social ergonomics of the device, the inclusion of paper in electronic medical records, addressing data fixation, and facilitating practitioners to make social changes to the interaction through the ability to make technical changes to the system