What Is Most Important: The Tradeoffs of Structuring Value Documentation in Electronic Health Records

Abstract

Advance Care Planning (ACP) enables patients to articulate the values that guide their end-of-life decisions, thereby improving health outcomes as they near death. However, Electronic Health Record (EHR) systems often fail to consistently support the documentation and transfer of these values across care settings. To investigate how ACP values are encoded, transmitted, and interpreted between hospital-based palliative care teams and hospice professionals, we conducted a narrative network analysis of twelve interviews with clinicians from both domains. Our analysis maps ACP value documentation workflows and reveals technical and organizational barriers – such as incompatible systems, unstructured or non-searchable formats, and mismatched assumptions about roles – that disrupt continuity of care. While more structured EHR fields may enhance usability, most value documentation remains under-structured, unstructured, or omitted, limiting searchability and interoperability. Building on prior CSCW research on healthcare coordination across distributed stakeholders, this study offers design recommendations for EHR systems and organizational practices to better support value documentation in clinical settings.