Defensividad sensorial y problemas socio-emocionales

Recommendations

In addition to defining the eHealth information niche, this study was undertaken to answer the following questions:

1. How does the introduction of eHealth information into the family physician/patient examination process impact clinical workflow?

2. What are the potential barriers, challenges or improvements to

physician/patient examination and communication effectiveness created by patient eHealth information introduction?

3. What process improvements or best practices may be developed to better manage patient-introduced eHealth information that could enhance the productivity of the physician/patient examination process?

Even though this study interviewed a convenience sample of North Carolina family physicians, and the values used to calculate physician productivity were self- reported, the findings still indicate that physicians have developed methods to integrate

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eHealth information into the physician/patient knowledge transfer process and it is clearly a tool utilized during the physician examining patient activity as evident by the activity diagrams and its inclusion as a sub-subtask in the task structure charts. It has mainly impacted clinical workflow by adding another sub-subtask to the “Communicates with patient” subtask in the physician examining patient activity by creating an

“involuntary” tool for the physician to use and address during the examination process.

The potential barriers and challenges to physician/patient examination

effectiveness created by the introduction of eHealth information are the subtraction of physician/patient quality time discussing information about symptoms, medication side effects and diseases unrelated to the patient’s health concern. The potential improvements to physician/patient examination effectiveness created by patient eHealth information introduction are the physicians’ development of new methods for distributing and suggesting health information to their patients. However, no systematic guidelines, policies or procedures for recommending eHealth information to patients emerged from the physicians’ responses but rather an ad hoc combination of linking online resources to their practice web sites, verbally suggesting web sites, distributing printouts and

brochures, and referring patients to vendor recommended licensed content linked to electronic medical records systems.

Process improvement areas or opportunities to develop best practices for managing eHealth information that emerged from the study were the division of labor between the physician and their staff supporting the activity of examining patients. After

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modeling the physicians’ workflow with task structure charts and activity diagrams the support staff’s main role emerged as to enhance practice workflow efficiency while the physician’s main role was to improve the overall effectiveness and quality of the

physician/patient examination. This was indicated by the qualitative nature of the objects and outcomes categories of the physician examining patient activity (see Figure 9). Of interest is that “diagnosis” was mentioned as both an object and an outcome by the physicians, indicating that problem resolution may be the overall goal of the patient examination for these physicians.

The physicians’ responses contained detail about how support staff was

responsible for placing the patient in the examination room, checking their vital signs, taking their initial history, checking for immunizations needed, prepping patients for suturing/minor outpatient surgery and taking care of patient follow-up. All of these tasks can potentially increase patient volume and examination efficiency. This support enabled the physician to spend “quality” time with the patient thus increasing the effectiveness of the examination, diagnosis and treatment.

One issue physicians mentioned was the amount of time spent providing

information for audits to insurance companies and government entities such as Medicare. Electronic medical records systems provided ease of storage and retrieval of

documentation needed for these types of audits for the practices that had implemented electronic medical records. All physicians should utilize their electronic medical records

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systems for this type of information storage and management to facilitate audits by regulatory agencies and compliance of rules, laws and regulations.

Other interesting practice business model issues mentioned by the physicians were: (1) the current trend of hospitals buying private practices from Family Physician Nine and (2) the institutional guidelines and goals being developed for monitoring physician response time for patients through the medical center admissions group from Family Physician Six. If private practice business models are indeed changing and patient response time is being monitored for process improvement in medical center owned clinics, then in the future, electronic medical records systems may become a “tool” used to justify practice purchase price and/or document response time efficiency goals attained.

Conclusions

This study indicates that physician workflow and process efficiency

improvements may be gained by moving the eHealth information niche currently residing in the physician/patient examination activity, and the recommending of eHealth

information sites that coincides with it, by delegating it to the office support staff. This workflow model is similar to the model currently in the urgent care center described by Family Physician Three.

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This could be accomplished by simply tagging patients as eHealth seekers in their medical chart/electronic medical record, to remind the staff to discuss this type of

information during the staff/patient encounter, prior to physician/patient examination. This method of tagging could also be utilized for patients with low health literacy, language comprehension and cultural issues to alert the support staff to direct the patient to “easy to read” resources and resources in their native language. This could be

accomplished with minimal support staff training in the areas of health literacy,

evaluation of eHealth information and electronic medical records systems. Utilizing these changes in process may minimize eHealth information introduction’s effect on the

examination and knowledge transfer effectiveness by ensuring that only “quality” eHealth information is discussed during the physician/patient examination.

This study indicates a need for the development of policies, procedures and best practices for integrating eHealth information into medical practice workflow to replace the ad hoc methods currently being utilized. Developing these types of guidelines has the potential to improve operational efficiencies for the medical practice. Improving

operational efficiencies could improve physician productivity and enhance quality of patient care by optimizing time spent with the patient during the physician/patient examination activity. Additional studies should also be conducted to determine best practices for integrating eHealth information with electronic medical records and utilizing ePatient portals for secure, HIPAA compliant, physician/patient communication to

enhance workflow efficiency optimization and knowledge transfer effectiveness. This can best be accomplished through continuing education for both the physicians and their

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support staff, work studies to evaluate redundancy in the physician examining patient activity and moving the eHealth information tool from the physician’s activity tool kit to the support staff’s activity tool kit.

In addition this study may offer more opportunities for research in Information Science, specifically work studies involving human/computer/information interaction. With the implementation of electronic medical records systems occurring in physicians’ clinical practices and their subsequent integration with pharmacy and hospital systems, this type of research may offer insight into new design methods for integrating eHealth information with patient electronic medical records systems to support physician/patient examination process improvement. Future researchers interested in eHealth information and physician/patient communication might examine the role of new or next generation technologies and their impact on clinical workflow, process improvement or early adopters in the medical field.

As the literature suggests and this study supports, patients are continuing to seek health information online (Eudy, 2010) and family physicians have managed to integrate its introduction into their work methods. However, this study pinpointed three strategic areas where improvement within the process may improve the physician/patient

knowledge transfer process such as: (1) utilizing electronic medical records, computers in the examining room and input of data by physicians during examination to improve physician productivity and reduce human error, (2) delegating to support staff the discussion of eHealth information and the linking of web sites to patient’s electronic

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medical records, ePatient portals and medical practice web sites to increase

physician/patient “quality” time during the examination activity, (3) developing best practices for annually evaluating resources suggested by physicians or linked to physician’s medical practice web sites for any changes in content, sponsorship of sites and ability to support patient health literacy. By utilizing technology, delegating duties and developing best practices more physician time should emerge for practicing medicine and less time choosing and critiquing health related web sites which could result in improving the physician’s examination goal of providing better patient health outcomes.

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