Test results management and distributed cognition in electronic health record-enabled primary care.

Michael W Smith,Ashley M Hughes,Praveen Mehta,Elise Russo,Charnetta Brown,Traber D Giardina,Hardeep Singh

doi:10.1177/1460458218779114

Abstract

Managing abnormal test results in primary care involves coordination across various settings. This study identifies how primary care teams manage test results in a large, computerized healthcare system in order to inform health information technology requirements for test results management and other distributed healthcare services. At five US Veterans Health Administration facilities, we interviewed 37 primary care team members, including 16 primary care providers, 12 registered nurses, and 9 licensed practical nurses. We performed content analysis using a distributed cognition approach, identifying patterns of information transmission across people and artifacts (e.g. electronic health records). Results illustrate challenges (e.g. information overload) as well as strategies used to overcome challenges. Various communication paths were used. Some team members served as intermediaries, processing information before relaying it. Artifacts were used as memory aids. Health information technology should address the risks of distributed work by supporting awareness of team and task status for reliable management of results.

Highlights

Coordination across the landscape of healthcare delivery is essential for quality care.[1]
The specific goal of this study is to explore how primary care teams in an integrated EHRenabled system address the challenges associated with management of abnormal test results
From another Veterans Affairs (VA) Medical Center (VAMC): Results from a Patient Aligned Care Teams (PACTs) patient seeing specialty care at another VAMC are sent to the registered nurses (RNs) Care Coordinator of the local VAMC, who sends them to the PACT

Summary

Introduction

Coordination across the landscape of healthcare delivery is essential for quality care.[1] As specialization permeates the outpatient care setting, the increasing use of information technology, homecare,[2] telemedicine,[3] and mobile health[4] cause communication and coordination to grow in complexity. Electronic health record (EHR) systems may facilitate coordination;[5] yet several barriers to effective EHR implementation are noted.[6,7]. Primary care teams often coordinate care across various healthcare services and manage patients at different stages of care. This involves frequent task switching[8] and remembering pending tasks.[9] Technology often influences communication and collaboration among key players, and management of task switching and pending tasks

Objectives

Results

Conclusion