Understanding Primary Care Teamwork in Context: Implications for Health Information Technology Design

Primary care is often the first point of contact within the healthcare system, involving the widest scope of care and significant breadth of knowledge from the primary care provider. The vast utilization of primary care comes with considerable complexity, especially under pressure to provide the highest quality of care in an efficient manner. Such stress can leave the provider feeling disorganized and experiencing burnout early in their career, along with creating dissatisfaction among patients. We lack digital healthcare tools that provide cognitive support to primary care clinicians. Cognitive support includes resources designed to assist in processes such as information searching, situation assessment, problem identification, and problem solving, all related to making a clinical diagnosis. Primary care providers need and deserve systems that facilitate high-quality care in a comprehensive, organized, and efficient manner.

This research informed the design of an electronic health record (EHR) prototype to support the cognitive work of primary care clinicians and teams. With the development and implementation of improved EHR interfaces, data displays, and input requirements, this work aims to support and extend clinician and team cognitive work to improve patient outcomes.

The specific aims of the research were as follows:

• Identify the cognitive work requirements of primary care clinicians and teams. 
• Test specific EHR interface design requirements. 

The research team recruited eight primary care clinics in the midwestern area of the United States through a research partnership with the Wisconsin Research and Education Network (WREN). To identify the cognitive work requirements as part of the first aim, the research team used a cognitive task analysis technique--Goal Directed Task Analysis (GDTA)--through clinical surveys, clinician interviews, observations, and data analysis. Using these data, the team developed GDTA maps outlining situation awareness needs among different types of primary care providers and identified areas of improvement among the EHR interface. The second aim of testing EHR designs required in-person and online design sessions among primary care providers. End-user testing was performed for clinician feedback to determine an appropriate EHR design to facilitate straightforward system navigation. The final prototype, called the Tandem EHR, included a variety of functionalities focused on goal-directed work such as schedule coordination, task assignment, and information sharing.

The research team found that cognitive support for primary care providers is an evolving paradigm with numerous facets. While the initial goal of this research aligned with supporting patient visit-related work, the research expanded the scope to include electronic healthcare and patient followup aftercare. Positive results and feedback from the Tandem EHR end-user testing suggests that such technical support could improve cognitive work of all primary care providers and, in turn, improve quality of care among patients.