We need to talk: an observational study of the impact of electronic medical record implementation on hospital communication

BACKGROUND: Increasing attention is being given to the importance of communication in the delivery of high-quality healthcare. We sought to determine whether communication improved in a hospital setting following the introduction of an electronic medical record (EMR). METHODS: This pre-post cohort design enrolled 75 patient-nurse-physician triads prior to the introduction of EMR, and 123 triads after the introduction of EMR. Nurses and patients reported whether they communicated with the physician that day. Patients, nurses and physicians answered several questions about the plan of care for the day. Responses were scored for degree of agreement and compared between pre-EMR and post-EMR cohorts. The primary outcome was Total Agreement Score, calculated as the sum of the agreement responses. Chart review was performed to determine patients' actual length of stay. RESULTS: Although there was no difference between the frequency of nurses reporting communication with physicians before and after EMR, face-to-face communication was significantly reduced (67% vs 51%, p=0.03). Total Agreement Score was significantly lower after the implementation of EMR (p=0.03). Additionally, fewer patients accurately predicted their expected length of stay after EMR (34% vs 26%, p=0.001). CONCLUSIONS: The implementation of EMR was associated with a decrease in face-to-face communication between physicians and nurses, and worsened overall agreement about the plan of care.