Unmet information needs of clinical teams delivering care to complex patients and design strategies to address those needs

Abstract

Objectives To identify the unmet information needs of clinical teams delivering care to patients with complex medical, social, and economic needs; and to propose principles for redesigning electronic health records (EHR) to address these needs. Materials and Methods In this observational study, we interviewed and observed care teams in 9 community health centers in Oregon and Washington to understand their use of the EHR when caring for patients with complex medical and socioeconomic needs. Data were analyzed using a comparative approach to identify EHR users’ information needs, which were then used to produce EHR design principles. Results Analyses of > 300 hours of observations and 51 interviews identified 4 major categories of information needs related to: consistency of social determinants of health (SDH) documentation; SDH information prioritization and changes to this prioritization; initiation and follow-up of community resource referrals; and timely communication of SDH information. Within these categories were 10 unmet information needs to be addressed by EHR designers. We propose the following EHR design principles to address these needs: enhance the flexibility of EHR documentation workflows; expand the ability to exchange information within teams and between systems; balance innovation and standardization of health information technology systems; organize and simplify information displays; and prioritize and reduce information. Conclusion Developing EHR tools that are simple, accessible, easy to use, and able to be updated by a range of professionals is critical. The identified information needs and design principles should inform developers and implementers working in community health centers and other settings where complex patients receive care.

Uncovering the Value of a Historical Paper-Based Collaborative Artifact: The Nursing Unit's Kardex System

“…In this study, care teams, including nurses, in community health centers in Oregon and Washington provided care using electronic health records, and the findings described 10 unmet information needs. Their first reported unmet information need was that information about social determinants of health was inconsistent and infrequently updated in the electronic health record ( 23 ).…”

Factors impacting clinical data and documentation quality in Australian aged care and disability services: A user-centred perspective

“…However, there is limited guidance available to direct aged care and disability service providers in what constitutes optimal documentation (Cohen et al, 2020). This is in contrast to hospital and primary care settings where standardised national guidelines for health information documentation exist (Austalian Commission on Safety and Quality in Healthcare, n.d.; The Royal Australian College of General Practitioners, 2023).…”

“…Poor data quality is a major barrier to the effective use of CIS (van der Veer et al, 2010) and can lead to healthcare errors (El-Kareh et al, 2013;Schiff and Bates, 2010), awed business decisions, and increased operating costs (Gorla et al, 2010). Reliable clinical data is therefore imperative for health service performance and has made data quality an essential part of information systems research and practice in recent years (Al-Abdullah and Weistroffer, 2011).Optimising data quality within health services is expected to contribute to improved patient outcomes (Department of Social Services, 2021), support reporting requirements, and reduce operating costs.However, there is limited guidance available to direct aged care and disability service providers in what constitutes optimal documentation (Cohen et al, 2020). This is in contrast to hospital and primary care settings where standardised national guidelines for health information documentation exist (Austalian Commission on Safety and Quality in Healthcare, n.d.; The Royal Australian College of General Practitioners, 2023).…”

Integrated, Personalized Care for Older People

“…That knowledge of the person in context allows them to help the older person and family to prioritize the most important aspects of care, taking a life course perspective and integrating care across multiple chronic illnesses, acute concerns, preventive opportunities, mental health, and family care (Stange, 2009b). Ideally it involves communication, rather than diffusion of responsibility, among health care teams (Balasubramanian et al, 2010; Bolen & Stange, 2017; Chesluk & Holmboe, 2010; Cohen et al, 2020; Friedman, 2021; Hoff et al, 2021; Jabbarpour, 2016; Pany et al, 2021; Rodriguez et al, 2007; Sinsky et al, 2010).…”