Table 2. Key features of included publications.

Author/ Year/ Country	Study design	Population and setting	Intervention	Outcome measure	Effect (+/ -/ ∼)	Significant results/conclusions	Study quality QATSDD a
Abraham et al 2019 United States 47	Prospective, non-randomized pre-post study design	Twenty-seven participants (medical and pharmacy) across two teams participated in 169 patients rounds at an academic medical center.	EHRE: EHR integrated Rounding Report Tool (RRT) Comparator: Microsoft Word fillable rounding tool (usual tool)	Communication: Clinical content discussed Questions raised Breakdowns in interactive communication	+ Positive effect on communication	Fewer questions (RRT = 7.5 (6.4), usual =10.6 (6.9), p  = 0.03), and fewer incorrect responses when using RRT (RRT =0.07 [0.4], usual = 0.6 [1.3], p  = 0.01); no differences for missing information between the two tools (RRT = 0.5 [0.9], usual = 0.6 [0.7], p  = 0.5). Quality of interactive communication was improved with the RRT with fewer interruptions through questions, and fewer incorrect responses to questions.	69%
Asan et al 2018 United States 52	Cross sectional concurrent mixed methods study design	Thirty-six participants: 19 medical and 27 nurse practitioners (NPs) in the pediatric intensive care unit (PICU)	EHRE: Large Customizable Interactive Monitor (LCIM) in each patient room; data updated from EHR; view only	Perceived usefulness Perceived ease of use User satisfaction	+ Positive effect on communication ∼ No effect on coordination	Improved sharing of information with care team (score 2.65; range 0–6); 70% responses showed “moderate amount/quite a lot” Low effect on organization for each patient (score 1.79; range 0–6); 58% responses showed “not at all/a little.” The LCIM was perceived primarily positive by PICU medical and NPs, both for themselves and the patients and families.	79%
Ash et al 2003 United States 53	Multisite qualitative study design	Participant observations, focus groups and interviews across three hospital facilities: 72 clinicians (unspecified) Eight IT staff Seven administrators	EHR: Computerized Physician Order Entry (CPOE) “a process that allows direct entering of medical orders”	Staff perspectives of success factors for implementing CPOE	+ Positive effect on communication - Negative effect on coordination	Improved legibility with CPOE Medical and nursing communication positively changed as a result of CPOE (more interdependent). Lack of integration of various IT systems (e.g., CPOE with laboratory results) reduced coordination as information not accessible in a single place.	83%
Cheng and South 2020 Australia 54	Retrospective cross sectional study design	Usage audit of all users of the Electronic Task Management (ETM) system in a pediatric hospital	EHRE: ETM system allows requesting and resolution of nonurgent tasks between all clinicians	Usage: type of task, urgency of task, requestor role, and time to completion	+ Positive effect on communication	Majority of tasks were ordered by nurses for medical staff to complete (97.1%) A high level of closed-loop feedback with 77.4% of all tasks marked as completed within their requested timeframe and all tasks eventually completed. Widespread adoption and a key platform for nursing-medical clinical communication.	45%
Dalal et al 2017 USA 55	Observational study design	Usage audit of all users of the microblog in a medical intensive care unit and 2 non-critical care units and participant survey: 21 medical 7 nursing 1 care coordinator	EHRE: “Microblog” messaging platform to view, contribute, and communicate plans of care via a single forum and synchronization with EHR	Usage and messaging activity Useful features and barriers	+/− Mixed effects on communication + Positive effect on coordination	82.8% agreed that the microblog allowed transparent conversation that all care team members can view. Barriers were the availability of other messaging modalities (e.g., pagers, email, texting), poor awareness of the system, and inability to communicate with out-of-network providers. 49.4% of messages discussed care coordination; 27.2% of messages discussed care team collaboration; 65.5% respondents stated that the application was useful for improving plan of care concordance.	55%
Goldman et al 2012 Canada 56	Prospective mixed methods case study design	Usage audit (non-identifiable data) in a colposcopy clinic in large teaching hospital and 24 participant interviews: eight medical 10 nursing six IT	EHRE: Colposcopy Information System (CIS), cumulative electronic note on patient history, examination, treatment plans to view on one screen	Usage/uptake of CIS by staff Staff perceptions of CIS	+/− Mixed effects on communication +/− Mixed effects on coordination	Positive: system prompts prevented clinicians from forgetting to input important information. Mixed: physicians were unsure if nurses were taking patients histories accurately. Negative: interprofessional communication time increased. Positive: visibility of information. Negative: unclear responsibility for inputting the data and coordination of care.	44%
Hertzum and Simonsen 2008 Denmark 48	Mixed methods pre-post intervention	Observation and survey of medical and nursing staff in an acute stroke unit who attend team conferences, ward rounds, and nursing handovers.	EHR: Electronic patient record trial in an acute stroke unit for 5 d Comparator: paper-based records	Mental workload Missing pieces of information Importance assigned to tasks Responsibility for tasks.	+ Positive effect on coordination (medical). ∼ No effect on coordination (nursing) + General positive effect on coordination	Medical: Clarity of the importance of assigned work tasks and responsibility for tasks significantly improved while mental workload reduced with use of EHR compared with paper. Nursing: No difference in clarity about plan of care for nursing of the patient or for the medical treatment of the patient and no change in mental workload. Reduction in missing pieces of information (0.90 with paper records and only 0.17 with EPR) and messages to pass on with EHR compared with paper.	48%
Hyde and Murphy 2012 USA 49	Pre post pilot study	Pre-post survey of nursing and ancillary staff (PT, pharmacy, nutrition, respiratory therapy, case management, social work) in a 28-bed medical-surgical department	EHRE: Computerized clinical care pathway Comparator: paper-based care plan	Staff perceptions Documentation	+ Positive effect on communication + Positive effect on teamwork	“Communication of information from the clinical pathway during shift report (patient hand-off)” 34% increase (28% paper n  = 29 to 62% electronic n  = 21). “Documentation by ancillary staff on the pathway” 31% increase (60% paper n  = 15 to 91% electronic n  = 23). “The clinical pathway allows for a multidisciplinary approach to patient care” 24% increase (71% paper n  = 34 to 95% electronic n  = 22).	21%
Lloyd et al 2021 Australia 57	Observational study	Participant survey of 297 medical and nursing staff from both hospital and primary care	EHR: Electronic health record	Clinician perceptions on usability, technical quality, ease of use, benefits, collaboration	+ Positive effect on collaboration + Positive effect on communication	Of 199 respondents specific to hospital setting ( n  = 143 medical, n  = 56 nursing), 62.1% of medical and 72% of nursing staff agreed that the EHR supports collaboration and information exchange between clinicians in the same services.	67%
Morrison et al 2008 UK 50	Qualitative observational pre-post study	Participant observation and video analysis of ward rounds in ICU: medical, nursing and allied health including pharmacy, dietetics and physiotherapy. Participant interviews of 7 medical and nursing staff	EHR: Electronic patient record (Metavision)	Interaction between members of a multidisciplinary team during ward rounds	-Negative effect on communication and collaboration ∼ No effect when strategies to mitigate were implemented	Physical setup of the EHR (group formation, non-verbal behavior, access to patient data, and reaction to patient data) decreased interaction or openness of discussion, resulting in staff having less understanding of the patient goals. The easy access to information that the EHR provided did not encourage the usual trading of information that stimulates multidisciplinary interaction.	45%
Munoz et al 2014 USA 58	Mixed methods observational study	Participant survey of 4 medical and 16 nursing staff in a pediatric intensive care unit (PICU)	EHR: Electronic health record	Workflow issues impacting on efficiency and satisfaction (tasks, activities, and barriers)	- Negative effect on communication ∼/- No effect or negative effect on coordination	Three main areas of dissatisfaction in information flow: IT system, communication, and coordination. The IT system was perceived to have a negative impact on communication and coordination. 75% medical and 50% nursing staff believe the information flow in the EHR needs to be improved.	36%
Nelson et al 2017 USA 59	Ethnographic qualitative research design	Participant observation: medical, nursing and medical assistants in a hospital emergency department (ED) Participant interviews: medical and nursing leadership	EHRE: eSignout (electronic handoff tool) for automatic signout information and patient transfer from ED to medical ward	Social elements of clinical and organizational interactions of the key stakeholders with eSignout	+ Positive effect on coordination + Positive effect on communication + Positive effect on collaboration + Positive effect on teamwork	eSignout largely replaced verbal communication for handoffs leading to reduced disruption to workflows. When verbal communications were required, they were relevant, patient-centered, and succinct. eSignout allowed staff to gain a more coherent picture of the patient, improving communication and care for patients. Teamwork and collaboration improved through increased mutual respect and a shared understanding of clinician's respective time pressures	45%
Rogers et al 2013 USA 51	Pre-post study design	Documentation audit; comparing medical and nursing documentation pre and post implementation in an acute hospital setting	EHRE: Electronic tool to identify, communicate and document Present On Admission (POA) Pressure Ulcers (PrUs)	Communication and documentation of POA PrUs	∼ No effect on communication	The implementation of the electronic prompt did not contribute to the improvement in the communication process between the admitting physicians and the clinical nurses because the improvement in POA PrUs rates occurred before the EHR prompt intervention.	29%
Samal et al 2016 USA 60	Qualitative study design	29 participants: clinicians and information technology professionals from six regions chosen as national leaders in HIT	EHR: Health Information Technology (HIT) specifically focused on EHR	Care coordination: patient level, provider level and systems level	+ Positive effect on coordination (patient level) ∼/- No effect/ negative effect on coordination (provider level) +/− Mixed effect on coordination (system level)	Positive uses of HIT to “assess patients' needs and goals,” “monitor, follow-up and respond to change” and some examples of HIT to “support patients' self-management goals.” HIT was occasionally used in “establishing accountability” and “communication” however, processes were inefficient and had a negative impact on information transfer due to lack of interoperability.	79%
Sidlow and Katz-Sidlow 2006 USA 61	Cross sectional observational pilot study	Participant survey of 19 nurses on a general medical acute care unit	EHRE: Electronic sign-out tool	Communication between nursing and medical staff	+ Positive effect on communication + Positive effect on coordination	Communication between medical and nursing staff improved—score 4.6 (where 5 greatly improved and 1 worsened). Coordination improved by nurses' access to the sign-out tool allowing development of an accurate daily nursing plan of care – score 4.3.	29%
Varpio et al 2009 Canada 43	Qualitative study	Participant observation of 9 medical and 62 nursing staff in one ward of a pediatric hospital Interviews: 9 medical and 11 nursing staff	EHR: Electronic patient records	Interprofessional communication strategy	∼/- No effect/ negative effect on communication ∼/- No effect/ negative effect on collaboration	34% of communication mediated by the EHR resulted in a workaround: 6/44 workarounds Participants intentionally stopped using the system as it impeded workflow; 30/44 workarounds participants deliberately compromised their work patterns to adopt pathways allowed by the system. Senior medical staff were more likely to display a heightened awareness of the interprofessional effects of workarounds compared with junior staff.	81%
Ward et al 2012 USA 62	Prospective, nonexperimental evaluation study	840 participant surveys: 48 medical 341 nursing 451 other clinical across 7 hospitals	EHR: Clinical information system of EHR and CPOE	Perception of communication and information flow	∼ No effect on communication	Staff perceptions of communication were not affected with implementation of the EHR: “Communication between medical and hospital staff is adequate to meet patient care needs” Baseline 4.7 (1.2); Pre-implementation 4.7 (1.0); post implementation 4.6 (1.2)	52%

Abbreviations: EHR, electronic health record; EHRE, electronic health record enhancement.

^a Authors of the QATSDD tool suggest that scores >60% are considered at low risk of bias. 46