JMIR Publications

ABSTRACT

Background:

Redesigning Electronic Medical Record (EMR) systems is needed to improve their usability and usefulness. Like other artifacts, EMR systems can evolve with time and exhibit situated roles. Situated roles refer to the ways a system is appropriated by its users, i.e., the unintended ways the users engage with, relate to, and perceive the system in its context of use. These situated roles are usually unknown to the designers since they emerge and evolve as a response by the users to a contextual need or constraint. Understanding the system’s situated roles can expose the unarticulated needs of the users and enable redesign opportunities.

Objective:

The aim of this work is to find EMR redesign opportunities by understanding the situated roles of EMR systems in antenatal care settings.

Methods:

We conducted a field-based observational study at a Japanese antenatal care clinic. We observed three obstetricians and six midwives providing antenatal care to 37 pregnant women. We looked at how the EMR system is used during the checkups. We analyzed the observational data following a thematic analysis approach and identified the situated roles of the EMR system. Finally, we administered a survey to validate our results and understand the attitudes of the antenatal care staff regarding the situated roles of the EMR system.

Results:

We identified ten distinct situated roles that EMR systems play in antenatal care settings. Four roles were regarded as favorable as most users wanted to experience them more frequently. Four roles were regarded as unfavorable as most users wanted to experience them less frequently. Two ambivalent roles highlighted the providers’ reluctance to document sensitive psychosocial information in the EMR and their use of the EMR system as an accomplice to pause communication during the checkups. To improve the usability and usefulness of EMR systems, designers can amplify the favorable roles and minimize the unfavorable roles. Our results also showed that obstetricians and midwives may have different experiences, aspirations, and priorities regarding the use of the EMR system.

Conclusions:

Currently, EMR systems are mainly viewed as tools that support the clinical workflow. Redesigning EMR systems is needed to amplify their roles as communication support tools. Our results provided multiple EMR redesign opportunities to improve the usability and usefulness of EMR systems in antenatal care. Designers can use the results to guide their EMR redesign activities and align them with the users’ aspirations and priorities. The biggest challenge is to redesign EMR systems in a way that amplifies their favorable roles for all the stakeholders concurrently.