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). Design, participants, intervention, setting 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.