Using Health Information Technology in Practice Redesign: Impact of Health Information Technology on Workflow (Massachusetts)

Project Final Report (PDF, 3.82 MB)

Project Details - Ended

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Summary:

While the use of applications by individuals to collect personal health data has been increasing, enabling patients to electronically share this information with their clinicians is relatively new. There is some evidence that health outcomes improve by the introduction of patient portals or allowing patients to provide information electronically; and some evidence indicating that these health IT applications may improve process measures, such as greater adherence, better self-care, improved patient-provider communication, and patient satisfaction. However, the impact of electronically sharing this data with care providers is poorly studied, with unknown impact to workflow within clinics.

This project studied the impact on workflow of applications that allow patients to electronically share information with clinics on workflow. It also looked at how clinics redesign information workflows to incorporate patient generated data.

This project addressed three research questions:

  1. How does the use of health IT to capture and use patient-reported information support or hinder the workflow from the viewpoints of clinicians, clinic staff, and patients? 
  2. How does the sociotechnical context influence workflow related to the capture and use of patient-reported information? 
  3. How do clinics (clinic staff and providers) redesign their workflows to incorporate the capture and use of patient-reported information? 

The project team focused on the impact on workflow when clinics incorporate information electronically shared by patients via three types of mechanisms: secure messaging, e-forms, and the use of a patient portal to upload data. A multiple case study design with mixed methods was used for data collection. Participants were primary care clinics located in medium-sized cities, two located in the Southeastern United States and four in the Midwestern United States. The clinics provided primary care, used one or more health IT applications that allowed patients to report information electronically, and were either small (four or fewer full time physicians) or medium-sized (five to 10) practices. Data was collected during conference calls, with questionnaires, during tours of the clinics, with interviews, and with surveys.

The project team found that allowing patients to share their information with clinicians electronically facilitated communication, improved the organization of work, reduced workload, and increased patient satisfaction. However, the team also found that while the use of these technologies had benefits, they can also hinder workflow and may increase physicians’ workload. In addition, usability issues of applications represented a significant workflow barrier.

Using Health Information Technology in Practice Redesign: Impact of Health Information Technology on Workflow - 2012

Summary Highlights

  • Principal Investigator: 
  • Organization: 
  • Funding Mechanism: 
    Accelerating Change and Transformation in Organizations and Networks (ACTION II)
  • Contract Number: 
    290-2010-00031I-2
  • Project Period: 
    August 2012 – August 2015
  • AHRQ Funding Amount: 
    $774,162
  • PDF Version: 
    (PDF, 198.93 KB)

Summary: Ambulatory care settings are increasingly using health information technology (IT) to capture patient reporting of medical histories, symptoms, results of self-testing (e.g., blood glucose levels, blood pressure), weight questions and concerns, over-the-counter medication use, and other information that patients need to share with their care providers. Although health IT can help facilitate making information more readily available to providers as they formulate a patient’s treatment plan, smaller physician practices may find it difficult to implement health IT to maximize benefit while minimizing disruption.

This project is one of three contracts awarded under the Agency for Healthcare Research and Quality Accelerating Change and Transformation in Organizations and Networks II (ACTION II) request for task order (RFTO) titled ‘Using Health IT in Practice Redesign: Impact of Health IT on Workflow.’ The goal of this RFTO is to fund methodologically rigorous research studies on health IT implementation to support practice redesign in ambulatory care settings and to enhance understanding of the causal relationship between health IT and workflow processes.

The project, led by Dr. Pascale Carayon (principal investigator) from the University of Wisconsin- Madison and Andrea Hassol (project director) from Abt Associates, will use a case study research design to explore the influence of sociotechnical factors—such as practice characteristics, physical environment, or communication flows—on clinicians, office staff, and patients in capturing and using patient-reported health information , both within an ambulatory practice and across multiple practices. The work will be guided by the Systems Engineering Initiative for Patient Safety (SEIPS) model. The team is using a combination of quantitative and qualitative methods to study six small- and medium-sized ambulatory care practices, conducting an in-depth case study of each, to describe the workflow related to patientreported health information from the viewpoint of multiple stakeholders. Study sites will be located in Alabama (assisted by researchers with the University of Alabama at Birmingham) and Wisconsin.

The study team will spend 3-4 days at each study site to conduct direct observations, interviews with clinical and office staff, clinician surveys, and patient interviews to create process maps and document work system barriers and facilitators to the integration of health IT in each site’s workflow. This information will be used for within-case and across-case analyses to understand how using health IT to capture and use patient-reported health information impacts clinical workflow.

Project Objective:

  • Explore the influence of sociotechnical factors on clinicians, office staff, and patients in capturing and using patient-reported health information, both within an ambulatory practice and across multiple practices. (Ongoing)

2012 Activities: The project began in August 2012. The focus of activity for the first few months was on establishing the necessary subcontracts, developing the research and analysis plans, and developing the Information Control Request (ICR) to obtain Paperwork Reduction Act (PRA) clearance. The ICR was drafted and underwent revisions after AHRQ review.

Preliminary Impact and Findings: The project has no findings to date.

Target Population: General

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to improve health care decisionmaking through the use of integrated data and knowledge management.

Business Goal: Knowledge Creation

Using Health Information Technology (IT) in Practice Redesign: Impact of Health IT on Workflow. Patient-Reported Health Information Technology and Workflow - Final Report

Citation:
Carayon P, Hoonakker P, Cartmill R, et al. Using Health Information Technology (IT) in Practice Redesign: Impact of Health IT on Workflow. Patient-Reported Health Information Technology and Workflow - Final Report. (Prepared by Abt Associates under Contract No. 290-10-00031I-2). AHRQ Publication No. 15-0043-EF. Rockville, MD: Agency for Healthcare Research and Quality. May 2015. (PDF, 3.82 MB)
Principal Investigator: 
Document Type: 
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