Designing for collaborative reflection

A significant problem with electronic health records (EHRs) has been their failure to fit into existing workflows because they do not support informal documentation and communication. We used qualitative fieldwork and participatory design to investigate how EHRs could be designed to meet these needs. The contributions of this work are twofold: we identified and described the informal processes of documentation and communication that we refer to as collaborative reflection, and then developed design recommendations for EHRs to support these existing workflows. We studied treatment teams providing behavioral and mental health services as part of integrated school programs for children with special needs. To make ongoing treatment decisions, team members document progress daily and communicate frequently with one another. Based on our fieldwork findings, we describe this process of collaborative reflection as (1) unstructured, (2) mobile, (3) reciprocally interdependent, and (4) long-term. We engaged the treatment teams in a participatory design process to understand how EHRs could be designed to fit this process, culminating in seven design recommendations. Our work suggests that by supporting the process of collaborative reflection, EHR-related information technology could significantly improve the efficiency and effectiveness of treatment teams.