Using information communication technology in models of integrated community-based primary health care: learning from the iCOACH case studies

Abstract

BackgroundInformation communication technology (ICT) is a critical enabler of integrated models of community-based primary health care; however, little is known about how existing technologies have been used to support new models of integrated care. To address this gap, we draw on data from an international study of integrated models, exploring how ICT is used to support activities of integrated care and the organizational and environmental barriers and enablers to its adoption.MethodsWe take an embedded comparative multiple-case study approach using data from a study of implementation of nine models of integrated community-based primary health care, the Implementing Integrated Care for Older Adults with Complex Health Needs (iCOACH) study. Six cases from Canada, three each in Ontario and Quebec, and three in New Zealand, were studied. As part of the case studies, interviews were conducted with managers and front-line health care providers from February 2015 to March 2017. A qualitative descriptive approach was used to code data from 137 interviews and generate word tables to guide analysis.ResultsDespite different models and contexts, we found strikingly similar accounts of the types of activities supported through ICT systems in each of the cases. ICT systems were used most frequently to support activities like care coordination by inter-professional teams through information sharing. However, providers were limited in their ability to efficiently share patient data due to data access issues across organizational and professional boundaries and due to system functionality limitations, such as a lack of interoperability.ConclusionsEven in innovative models of care, managers and providers in our cases mainly use technology to enable traditional ways of working. Technology limitations prevent more innovative uses of technology that could support disruption necessary to improve care delivery. We argue the barriers to more innovative use of technology are linked to three factors: (1) information access barriers, (2) limited functionality of available technology, and (3) organizational and provider inertia.

Integrating health care in Australia: a qualitative evaluation

“…However, challenges with information technology reduced the impact of these strategies and these problems persisted through our evaluation. Information technology whilst a key enabler of shared information [38, 39], is a common source of frustration in integrating health care [40–42] and in Australia there is a lack of effective information sharing between and within health sectors [34]. Toward the end of the evaluation some action plans were being e-mailed with discharge summaries to GPs, however, the predominant form of delivery was still hard copy either via the patient, or through facsimile or regular paper mail.…”

Toward a Person-Centred Learning Health System: Understanding Value from the Perspectives of Patients and Caregivers

“…Over the next few years, it will be important to determine the tools, processes and enabling contexts required by researchers, providers and decision makers to address the aspects of care that patients and caregivers identify as valuable. To date, a number of factors that support an enabling context for person-centred care have been identified and include providers who work in teams (Beland and Hollander 2011), co-location of services (Rumball-Smith et al 2014), care coordination (Beland and Hollander 2011), shared values (Evans et al 2016;Luxford et al 2011), data infrastructure that spans settings to support communication (Steele Gray et al 2018;Suter et al 2009), remuneration that does not penalize providers for taking time with patients and caregivers during care interactions (Hutchison and Glazier 2013;Tsiachristas 2016) and co-design of care with patients and caregivers (Evans et al 2016). In a PC-LHS, when patient and caregiver data are collected, having processes in place to frequently discuss and reflect on the data will be required, particularly because ideas and goals may conflict.…”

“…Another key challenge of a PC-LHS is the fragmentation of information technology and the lack of interoperability of information technology systems across the healthcare sector and between health and social service sectors (Steele Gray et al 2018). Although a hospital system may create a user-friendly information technology platform within their institution, data capturing the full patient journey will require some level of integration with other providers and systems across sectors.…”

From summative to developmental

“…Lessons learned from designing and evaluating ePRO and evaluating other complex technologies, as well as our experiences studying the implementation of international models of integrated care (Breton et al, 2017;Steele Gray, Wodchis, Baker, Carswell, Kenealy, McKillop, Breton, Parsons and Sheridan, 2018;Steele Gray, Barnsley, Gagnon, Belzile, Kenealy, Shaw, Sheridan, Wankah and Wodchis, 2018;Evans et al, 2017;McKillop et al, 2017;Kuluski et al, 2017;Shaw et al, 2017) suggest that the nuance and intricacy of leadership, personal relationships and different communication strategies is critical. These intangible qualities have been argued to be cornerstones of integrated care (Glasby, 2016).…”