Challenges to care coordination posed by the use of multiple health IT applications

Carayon, Pascale; Alyousef, Bashar; Hoonakker, Peter; Hundt, Ann Schoofs; Cartmill, Randi; Tomcavage, Janet; Hassol, Andrea; Chaundy, Kimberly; Larson, Sharon; Younkin, Jim; Walker, James M.

doi:10.3233/wor-2012-0746-4468

Cited by 25 publications

(18 citation statements)

References 7 publications

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“…Staff members only have a small amount of influence regarding this task. Part of the problem is that IT systems for health care documentation present many challenges [ 27 – 29 ], and most systems do not save time [ 30 , 31 ]. However, IT systems can reduce the work burden for care administrators [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Time utilization and perceived psychosocial work environment among staff in Swedish primary care settings

Anskär

Lindberg

Falk

et al. 2018

BMC Health Serv Res

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BackgroundOver the past decades, reorganizations and structural changes in Swedish primary care have affected time utilization among health care professionals. Consequently, increases in administrative tasks have substantially reduced the time available for face-to-face consultations. This study examined how work-time was utilized and the association between work time utilization and the perceived psychosocial work environment in Swedish primary care settings.MethodsThis descriptive, multicentre, cross-sectional study was performed in 2014–2015. Data collection began with questionnaire. In the first section, respondents were asked to estimate how their workload was distributed between patients (direct and indirect patient work) and other work tasks. The questionnaire also comprised the Copenhagen Psychosocial Questionnaire, which assessed the psychosocial work environment. Next a time study was conducted where the participants reported their work-time based on three main categories: direct patient-related work, indirect patient-related work, and other work tasks. Each main category had a number of subcategories. The participants recorded the time spent (minutes) on each work task per hour, every day, for two separate weeks. Eleven primary care centres located in southeast Sweden participated. All professionals were asked to participate (n = 441), including registered nurses, primary care physicians, care administrators, nurse assistants, and allied professionals. Response rates were 75% and 79% for the questionnaires and the time study, respectively.ResultsAll health professionals allocated between 30.9% - 37.2% of their work-time to each main category: direct patient work, indirect patient work, and other work. All professionals estimated a higher proportion of time spent in direct patient work than they reported in the time study. Physicians scored highest on the psychosocial scales of quantitative demands, stress, and role conflicts. Among allied professionals, the proportion of work-time spent on administrative tasks was associated with more role conflicts. Younger staff perceived more adverse working conditions than older staff.ConclusionsThis study indicated that Swedish primary care staff spent a limited proportion of their work time directly with patients. PCPs seemed to perceive their work environment in negative terms to a greater extent than other staff members. This study showed that work task allocations influenced the perceived psychosocial work environment.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-2948-6) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Time utilization and perceived psychosocial work environment among staff in Swedish primary care settings

Anskär

Lindberg

Falk

et al. 2018

BMC Health Serv Res

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“…Research has identified various challenges or barriers experienced by care managers who use multiple health information technology (IT) systems when coordinating care for chronically ill patients. These barriers include usability problems (e.g., poor interface design, lack of interoperability between applications) and organizational barriers (e.g., no access to some health IT applications) (Alyousef et al, 2012; Alyousef et al, 2017; Carayon et al, 2012). Some technology barriers may be removed through system redesign (e.g.…”

Section: Introductionmentioning

confidence: 99%

Technology barriers and strategies in coordinating care for chronically ill patients

2019

Self Cite

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Care managers who coordinate care for chronically ill patients in hospitals and outpatient settings use multiple health information technologies for accessing, processing, documenting, and communicating patient-related information. Using a combination of 41 interviews and observations of 15 care managers, we identified a range of technology-related barriers experienced by care managers (total of 163 occurrences). The barriers are related to (lack of) access to information, inadequate information, limited usefulness and usability of the technologies, challenges associated with using multiple health IT, and technical problems. In 43% of the occurrences, care managers describe strategies to deal with the technology barriers; these fit in three categories: nothing/delay (9 occurrences), work-arounds (32 occurrences), and direct action at the individual, team, and organization levels (29 occurrences). Our data show the adaptive capacity of care managers who develop various strategies to deal with technology barriers and are, therefore, able to care for chronically ill patients. This information can be used as input to work system redesigns.

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“…41,42 SEIPS has been used by health care researchers, professionals, and educators in both inpatient and outpatient settings to improve health outcomes, such as patient safety, quality of care delivery, transitions of care and coordination, usability, and implementation of health information technology, as well as managing a variety of health care activities, such as infection control, surgical readmissions, primary care workflows, and decision support. [43][44][45][46][47][48][49][50][51] The SEIPS model provides a framework for evaluating the complex interplay of work system factors that influence care processes and impact outcomes within the survivorship context. The work system can be conceptualized as a collection of elements: persons with roles and responsibilities (eg, survivors, oncologist, PCPs) performing tasks (eg, ordering a test) while using various tools/technologies (eg, EHR, decision support) in an environment (eg, office, clinician workroom, home) and an organizational context (eg, practice, health care system).…”

Section: Mastering Complexity: a Systems Engineering Approachmentioning

confidence: 99%

Moving beyond static survivorship care plans: A systems engineering approach to population health management for cancer survivors

Tevaarwerk

Klemp

Londen

et al. 2018

Cancer

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The American cancer survivor population is ever-growing, with necessary follow-up primarily accomplished in a high-touch fashion— adding to unsustainability and fragmentation of care. Given the complexities of the health care system processes needed to support survivorship, engineering approaches may best address performance deficits and facilitate the provision of patient-centered care. Such collaboration between health care and engineering is recommended for redesigning health care delivery systems. By using Systems Engineering Initiative for Patient Safety (SEIPS), a systems engineering model widely used to improve health care quality and delivery, the authors examine the work system to identify the barriers and facilitators to necessary care in the presence of a survivorship care plan and visit. Recommendations for future improvement include ensuring that care-planning processes are dynamic, clearly assigned, resilient, and integrated with electronic health record systems.

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Challenges to care coordination posed by the use of multiple health IT applications

Cited by 25 publications

References 7 publications

Time utilization and perceived psychosocial work environment among staff in Swedish primary care settings

Time utilization and perceived psychosocial work environment among staff in Swedish primary care settings

Technology barriers and strategies in coordinating care for chronically ill patients

Moving beyond static survivorship care plans: A systems engineering approach to population health management for cancer survivors

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