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

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.