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

Project Final Report (PDF, 2.07 MB)

Project Details - Ended

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Summary:

The need for effective health information technology (IT) to manage electronic patient data and to support redesigned systems of ambulatory care has expanded as the number of providers using electronic health record (EHR) systems has grown. Yet health IT and the work systems it supports are not always compatible. Health IT-workflow interactions, best understood through a human factors and sociotechnical framework, have not been extensively or rigorously studied, and published research is not always informative to organizations seeking to use health IT systems to support redesign of their ambulatory care settings. To address this gap, this project evaluated the multiple work activities, roles, and technologies in six primary care practices that introduced new health IT tools in their redesign of care coordination.

The specific objective of the project was as follows:

  • Understand the impact of implementing health IT-enabled care coordination on workflow within small community-based primary care clinics in various stages of practice redesign. 

A formal mixed-methods approach employed direct observation, patient and staff interviews and surveys, artifact and spatial data collection, and software use monitoring to study six site teams. The teams, located in primary care clinics at Vanderbilt University Medical Center, were in different phases of introducing My Health Team at Vanderbilt (MHTAV). MHTAV is a care coordination program that included a new care coordinator role and new health IT components called the MHT tools. In addition to using the existing Vanderbilt EHR system and patient portal, the MHTAV program added: 1) diabetes, hypertension, and congestive heart failure dashboards; 2) worklists used by the coordinators; 3) a plan of care for the patient; 4) a disease control form; 5) alerts and reminders; 6) a patient portal journal for sharing home monitoring information; and 7) an interactive voice response system. Iterative observations and supplemental data collected over 12 months for each site team were used to explore health IT-workflow interactions over time.

The overall impact of health IT on care coordination workflow was mixed, varying from good to neutral to poor, depending on the specific task, technology, user, and use of health IT. Five primary areas of care coordination work and two areas of supporting work were identified from analysis of interview and observation field notes. The primary work of the coordinators was: establishing and maintaining relationships with patients and a plan of care, collecting and analyzing home monitoring data, educating and coaching patients, and coordinating with other clinical staff and patients. Two additional activity areas supported their primary work: searching for information to support decisionmaking and action, and prioritizing tasks and planning work. Work in these seven areas was enabled by multiple forms of IT, including new health IT (MHT tools), existing health IT (the EHR, patient portal, online patient education materials, messaging, and online whiteboard), and general IT (scheduling system).

Using Health Information Technology in Practice Redesign - 2012

Summary Highlights

  • Principal Investigator: 
  • Organization: 
  • Funding Mechanism: 
    Accelerating Change and Transformation in Organizations and Networks (ACTION II)
  • Contract Number: 
    290-2010-00024l-4
  • Project Period: 
    June 2012 – May 2015
  • AHRQ Funding Amount: 
    $799,929
  • PDF Version: 
    (PDF, 195.87 KB)

Summary: Health information technology (IT) has the potential to improve the quality, safety, efficiency, and effectiveness of care. Yet anticipated benefits of health IT are difficult to achieve unless implementation and workflow challenges are identified and addressed.

The goal of this project is to understand the impact of implementing health IT-enabled care coordination on workflow in small community-based primary care clinics in various stages of practice redesign. These clinics, affiliated with Vanderbilt University Medical Center, are at different stages in adoption of a care coordination redesign program called My Health Team (MHT). The MHT program includes intensified patient engagement; dedicated care coordinators; and health IT tools to support care coordination redesign including registries, a shared care plan, alerts and reminders, at-home monitoring, and between-visit communication with patients. The research team will study technology-supported workflow for ambulatory care coordination of patients with diabetes in six clinics.

The project will employ a formal mixed-methods approach that uses direct observation, patient and staff interviews, surveys of staff and patients, artifact and spatial data, and software tracking in the clinics that have a common electronic health record but are in different phases of introducing practice redesign, including the health IT component of MHT. The data collection and analysis activities will be guided by the study’s theoretical framework that combines two compatible workflow research models: the Systems Engineering Initiative for Patient Safety model and the Workflow Elements model. Combining this formal approach with iterative observations and analysis among these clinics over 12 months will generate a detailed understanding of changes in health IT-workflow interaction for each clinic over time and across clinics in various implementation phases (pre-, early-, or mature-MHT).

Study findings will be used to develop detailed workflow and information models for each clinic and phase, determine health IT enablers and barriers to care coordination workflow, and to develop a health IT-workflow interaction matrix for specific care coordination work activities derived from observations, interviews, and collected data.

Project Objective:

  • Understand the impact of implementing health IT-enabled care coordination on workflow within small community-based primary care clinics in various stages of practice redesign. (Ongoing)

2012 Activities: The project began in June 2012 and focused on development of the research and data analysis plans. The research plan includes an introduction of the problem and research question; a description of gaps in the literature and motivations for this project; a description of the conceptual model that guides the methodological design; and a description of the research approach including site selection and recruitment, data collection activities, and draft data collection tools. The data analysis plan provides a summary of the study components and outlines the planned methodology for each analysis.

In addition, the team submitted the materials to AHRQ for the Office of Management and Budget clearance required to conduct the evaluation. The 60-Day Federal Register Notice was published October 31, 2012 (FR Doc. 2012–26596).

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

Target Population: Chronic Care*, Diabetes

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to support patient-centered care, the coordination of care across transitions in care settings, and the use of electronic exchange of health information to improve quality of care..

Business Goal: Knowledge Creation

*This target population is one of AHRQ’s priority populations.

Health IT-Enabled Care Coordination and Redesign in Tennessee - Final Report

Citation:
Wald JS, Novak LL, Simpson CL, et al. Health IT-Enabled Care Coordination and Redesign in Tennessee - Final Report. (Prepared by RTI International, under Contract No. 290-10-00024I-4). AHRQ Publication No. 15-0048-EF. Rockville, MD: Agency for Healthcare Research and Quality. June 2015. (PDF, 2.07 MB)
Principal Investigator: 
Document Type: 
Medical Condition: 
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