Introduction Inpatient care coordinators (ICCs) in the United States play a critical role in case management and care transition. ICCs spend a large amount of time in chart review and documentation through electronic health record (EHR) systems. However, significant knowledge gaps exist regarding their workflow barriers and their use of health information technology (Health IT). Using only quantitative or quantitative methods does not provide a comprehensive picture about ICC’s workflow due to its complex and dynamic nature. This work aimed to address this gap by conducting a mixed-methods study to understand the workflow of ICCs and identifying challenges in care deliver and documentation activities. Methods The study adopted a concurrent triangulation design including qualitative interviews with 12 ICC staff members in the United States followed by extraction of their EHR event logs for one month. The qualitative interview data were analyzed thematically, and the log data were analyzed statistically. The results were triangulated and interpreted. Results Three major workflow barriers faced by ICCs were identified: long travel time, heavy documentation load, and suboptimal communication. The event logs provided empirical evidence to support the workflow barriers identified in the interviews, especially in travel time and documentation load. Discussion ICC workflow has several inefficiencies. The study generated four design considerations to develop a Health IT solution: Mobility, EHR integration, Team-based Communication, and User Adoption to improve workflow efficiency and care coordination. Using a mixed-methods approach is effective and efficient in collecting and analyzing clinical workflow.
BACKGROUND Inpatient care coordinators (ICCs) play a critical role in case management and care transition because they address patient needs by referring them to available services and facilities prior to discharge. ICCs tend to spend a significant amount of time reviewing patient charts and documenting the cases using Electronic Health Record (EHR) systems. However, significant knowledge gaps exist regarding their clinical workflow and potential use of health information technology to improve work efficiency and job satisfaction. OBJECTIVE We aimed to address the gap by answering the research questions: 1) what is a typical day of an inpatient care coordinator? 2) what challenges exist in terms of their care delivery and documentation activities? and 3) what patterns in the EHR event logs reinforce our findings from the qualitative interviews? In addition, we aimed to demonstrate the feasibility of our novel mixed-method approach to study clinical workflow. METHODS A mixed-methods approach was developed and employed to understand ICCs workflow patterns and identify existing barriers to workflow. This approach involved data collection from semi-structured interviews and EHR event logs to construct a generalizable picture of all ICC workflow at the University of Cincinnati Medical Center (UCMC). The study consisted of 12 qualitative interviews with ICCs at UCMC, and their EHR event logs for one month. The qualitative interviews were analyzed using thematic analysis and the event logs were analyzed using statistical and pattern analysis. RESULTS We identified three major workflow barriers faced by ICCs: long travel time, heavy documentation load, and suboptimal communication. The event logs provided empirical evidence to support the workflow barriers identified during the semi-structured interviews, especially in travel time and documentation load. CONCLUSIONS ICC workflow has several inefficiencies. We recommend a mobile-based informatics solution with streamlined, intelligent, and EHR-linked documentation support. Our mixed-methods approach can be applied to other clinical settings and healthcare institutions. CLINICALTRIAL NA
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