Capturing Distributed Contributions to an Informal Work Process: A Hospital Facility Case Study

Electronic Medical Records (EMR) in academic medical centers often have additional complexity to them due to structural and organizational differences. Often the hospital operates independent of the medical school such as the physicians often work for the medical school, while the nurses and other ancillary departments work for the hospital. Such differences require special consideration when making changes to an EMR. The case study concerns an academic medical center where there are two ways to access the EMR. One methodology is to use a clinical computer on clinical floors within the hospital. A second methodology is the use of Citrix servers to access the EMR. Due to organizational differences, the EMR users access the system via two separate sets of Citrix servers. The hospital’s support staff controls one set of Citrix servers and the academic support staff controls the other set. Physicians and mid-level providers utilize the academic Citrix servers, but nursing and other ancillary departments use the hospital’s Citrix servers. With the servers controlled by separate teams, careful coordination is needed to ensure uniformity across the servers for a consistent user experience.