Introducing electronic messaging in Norwegian healthcare: unintended consequences for interprofessional collaboration

Abstract

Objective: The introduction of health information technologies (HIT) can lead to unintended consequences. We studied a newly introduced electronic messaging (e-messaging) system for communication between homecare providers and general practitioners (GPs) in Norway. The objective of this paper is to identify and discuss unintended consequences of the introduction of e-messaging, particularly how it affected collaboration between the groups.

Methods: Qualitative data from interviews with homecare staff (23), GPs (11), medical secretaries (5) and project managers (4), lasting in average 45min. Data was analysed using an interpretative approach.

Results: We highlight three unintended consequences, which broadly led to changes in work practices for homecare nurses and GPs. (1) Communicating via e-messaging led to less face-to-face contact between homecare nurses and GPs. Even though e-messaging meant the opportunity to communicate more efficiently both groups emphasised the need for sustaining interpersonal relations via face-to-face communication to collaborate efficiently. (2) E-messaging made it easy to be proactive and send information. Consequently, tasks and responsibilities were sometimes reconfigured in unexpected ways. (3) Nurses said that the fact that e-messages were automatically documented in the patient's electronic patient record (EPR) system gave more weight to their requests. Nurses experienced e-messages as a more powerful means of communication vis-à-vis GPs than other means of communication, thus making e-messaging a tool for empowering them in their collaboration with GPs.

Conclusion: Unintended consequences of HIT affect collaboration between healthcare workers. The consequences may be both desirable and undesirable. Previous research has mostly focused on the undesirable unintended consequences. We show that the introduction of e-messaging led to both desirable and undesirable unintended consequences for interprofessional collaboration. More insight into positive unintended consequences can be a resource in the reorganisation of work that often accompanies the implementation of HIT.

Keywords: Collaboration; Electronic mail; General practitioners; Homecare services; Unintended consequences.