Unit 5b Can HIT Hinder Communication and Care Coordination? HIT Design for Teamwork and Communication This material was developed by Johns Hopkins University,

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Presentation transcript:

Unit 5b Can HIT Hinder Communication and Care Coordination? HIT Design for Teamwork and Communication This material was developed by Johns Hopkins University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC

Objective Investigate ways in which HIT design can serve as a barrier to effective communication. Component12/Unit 52 Health IT Workforce Curriculum Version 2.0/Spring2011

Information Sharing “As the healthcare environment has grown more complex, the sharing of patient clinical information among multiple providers has become more problematic. Today’s hospital environment is characterized by the provision of complex care through short encounters with multiple providers, a situation fraught with opportunities for communication breakdowns that can lead to increased medical errors.” Benham-Hutchins & Effken, 2010 “As the healthcare environment has grown more complex, the sharing of patient clinical information among multiple providers has become more problematic. Today’s hospital environment is characterized by the provision of complex care through short encounters with multiple providers, a situation fraught with opportunities for communication breakdowns that can lead to increased medical errors.” Benham-Hutchins & Effken, 2010 Component12/Unit 53 Health IT Workforce Curriculum Version 2.0/Spring2011

HIT and Communication Information Technology Communication & Workflow Component12/Unit 54 Health IT Workforce Curriculum Version 2.0/Spring2011

HIT and Communication Barriers to Communication Component12/Unit 55 Health IT Workforce Curriculum Version 2.0/Spring2011 Perceptual differences Cultural differencesLanguage barriers Information overload Organizational complexity Inattention/memory limits Time pressuresDistraction/noise InterruptionsEmotions

HIT and Communication Communication is characterized by social interactions and norms Behavioral expectations Cues within a group When information technology is introduced into the social group, we need to plan for potential changes in communication patterns. Component12/Unit 56 Health IT Workforce Curriculum Version 2.0/Spring2011

HIT and Communication We don’t talk to each other the way we used to, and that has an impact on care. Component12/Unit 57 Health IT Workforce Curriculum Version 2.0/Spring2011

HIT and Communication HIT alters the form and pattern of communication and information exchange Design problems can interfere with the clarity of information communicated between providers Patch-work systems that do not interact with each other, or that interact inefficiently, and lead to gaps in information, resulting in error Component12/Unit 58 Health IT Workforce Curriculum Version 2.0/Spring2011

HIT and Communication Social Network Analysis Study of interaction pattern among people, departments, organizations, social groups “For example, physicians consult with one another in diagnosing a patient’s illness. They interact with nurses, pharmacists, and medical technicians in providing patient care. Physicians, clinics, hospitals, medical laboratories, home care agencies, and insurance companies may all share a common electronic medical record system.” Component12/Unit 59 Health IT Workforce Curriculum Version 2.0/Spring2011

HIT and Communication Social Network Analysis Who does the provider routinely refers patients to, consult with, discuss professional matters with, or take on-call coverage for? Relational Data Are there physician subgroups in the practice who have similar patterns of referrals, consultations, discussion, and on-call coverage? Clustering Component12/Unit 510 Health IT Workforce Curriculum Version 2.0/Spring2011

Semi-Structured Observation A Tool for Communication Analyses “Healthcare is a communication and information intensive sector with a history of mixed success in the introduction and usage of information systems. Some of the problems can be ascribed to simplistic design processes and methods unsuitable for the complexity of healthcare.” Component12/Unit 511 Health IT Workforce Curriculum Version 2.0/Spring2011 Sorby ID, & Nytro, O Analysis of communicative behavior: profiling roles and activities. International Journal of Medical Informatics; 79(6): e144-e151.

Semi-Structured Observation A Tool for Communication Analyses Speech Act = smallest unit in human communication; 3 kinds of meaning “It’s cold in here” means it is cold in here. Literal Meaning “It’s cold in here” might mean “turn off the air conditioning” Social Function Someone turns off the air conditioning Effect Component12/Unit 512 Health IT Workforce Curriculum Version 2.0/Spring2011 Austin, J. L. 1962, How to do things with words. Oxford University Press: England

Semi-Structured Observation A Tool for Communication Analyses Collects both quantitative & qualitative data about collaborative communication, focusing on roles, information types, and sources. Used to analyze pre-round communication practices in anticipation of information technology implementation Researchers developed profiles of Individual providers in one patient care unit Providers in corresponding roles on different units Specific activities such as drug-related events Component12/Unit 513 Health IT Workforce Curriculum Version 2.0/Spring2011

Semi-Structured Observation A Tool for Communication Analyses Categorize communicative acts Assertive (states a fact) Commissive (states that the speaker will perform a task) Directive (aims to make the listener perform a task) Expressive (state of mind of the speaker) Declarative (changes the world by statement) Used these profiles to inform the design of new information systems Component12/Unit 514 Health IT Workforce Curriculum Version 2.0/Spring2011

HIT and Communication Workflow Support & System Design Simultaneous Examples: Face-to- face; telephone Synchronous Communication Occurs at different times Examples: voice mail, , computer record Asynchronous Communication Component12/Unit 515 Health IT Workforce Curriculum Version 2.0/Spring2011

HIT and Communication Workflow Support & System Design “The physician in this case study attempted to make three consultations by landline telephone as the first mode of contact. In the case of consult #3, the physician called, paged, and called a second time, finally leaving a message with the secretary. Each of the three attempts at contact resulted in deferment to an asynchronous mode of communication. Perhaps, had the physician been able to rely on a single, trusted, method of communication, he could have saved time by forgoing the follow-up page and phone call.” Component12/Unit 516 Health IT Workforce Curriculum Version 2.0/Spring2011