Matriz FODA
META GENERAL
4.4.3 NUEVA META CENTRAL SSC
4.3.2.1. Facilitators and barriers to uploading data into patient portal identified by clinicians. Three providers offered insights about facilitators and barriers to workflow related to patients uploading data into a patient portal. Nurses were not aware of the health IT application, and provided no data. Results in Figure 21 show that providers frequently identified facilitators related to communication, the organization of work, satisfaction with the health IT application, patient safety and quality of care, and usability. Providers mentioned only barriers related to usability.
Figure 21. Facilitators and barriers to uploading data into a patient portal identified in clinician interviews (N=3)
As can be seen in Table 25, providers identified far more facilitators to the use of this health IT application (an average of 4.7 per interview) than barriers (0.7 per interview).
Table 25. Facilitators and barriers to uploading data into a patient portal identified by clinicians (N=3)
Dimension Facilitator Barrier
Amount of work 1 0 Task complexity/simplicity 1 0 Inappropriate use NA 0 Workaround 0 0 Usability 2 2 Communication/information flow 2 0 Ambiguity/clarity 0 0 Organization of work 2 0
Satisfaction with technology 3 0
Patient satisfaction 0 0
Quality of care/patient safety 3 0 Mean dimensions per interview
(SD)
4.7 (0.47)
0.7 (0.47)
Communication facilitators included the fact that patients who use the flowsheet give providers useful information about their health.
Most of the patients that are uploading their information, they’re already well aware of what their blood pressure readings are. They usually have their own paper copy too. But … it can be helpful for both of us because [at the clinic] we can get that information. (Clinic 5 Physician)
One provider particularly likes the structure of the information arriving through the flowsheet and the ability to display it in an organized way.
If they just send [the readings in a secure message], it’s very hard to go back and see it and get a flowsheet and see what’s happening. So if they’ll put it in a flowsheet, then it’s certainly nicer data, much easier to see it. (Clinic 5 Physician)
Other facilitators were related to the organization of work. Compared with having patients report the same information in a phone call to the nurse, providers preferred the flowsheet because patients enter the data, rather than “highly paid and busy clinic staff” (Clinic 1 Physician).
Providers stated that when patients frequently report information through the flowsheet, it allows the providers to postpone bringing some of those patients in for appointments. They can adjust patients’ medication and communicate the change to patients using secure messaging, providing care without a clinic visit or phone call.
All three providers also reported facilitators related to the quality of care and patient safety. For example, use of the flow sheet helps patients to manage chronic conditions: “I think that a diabetic [patient] who used the flow sheet identified what it was that was making his sugars high through that tool. I think that helped him to manage his condition” (Clinic 3 Physician). Providers also mentioned that the health IT application helps patients to identify readings that are outside of their normal range and to track the effects of their medications.
Usability facilitators included the fact that the information is sent directly to the provider and is easy to find again at a later time. A usability barrier is that the graphing function displays the earliest readings on the right side and the most recent readings on the left. Time series data are
4.3.2.2. Facilitators and barriers to uploading data into patient portal identified by clinic patients. Three patients of Clinic 5 who use a patient portal to upload information were
interviewed about this health IT application. As the results in Figure 22 show, these three patients identified facilitators related to quality of care and patient safety, the amount of work, usability, the organization of work, and satisfaction with the health IT application. Barriers were primarily related to usability, as well as the amount of work and satisfaction with technology.
Figure 22. Facilitators and barriers to uploading data into a patient portal identified in patient interviews (N=3)
Results in Table 26 show that patients identified more facilitators (an average of 2.7 per interview) than barriers (1.7 per interview).
Table 26. Facilitators and barriers to uploading data into a patient portal identified in patient interviews (N=3)
Dimension Facilitator Barrier
Amount of work 2 1 Task complexity/simplicity 0 0 Inappropriate use 0 0 Workaround 0 0 Usability 2 3 Communication/information flow 0 0 Ambiguity/clarity 0 0 Organization of work 1 0
Satisfaction with technology 2 1 Quality of care/patient safety 1 0 Mean dimensions per interview
(SD)
2.7 (2.05)
1.7 (0.94)
Two patients mentioned facilitators related to the amount and organization of work, specifically the amount of time required to share information with the clinic.
It’s probably less time of mine and the clinic’s [than sharing the information by phone], because making a phone call, you’d have to find the right person. ... [It] would have to be to one of the nurses for my doctor. I’d be on hold for a while, and then we’d both be spending [several minutes] to write down numbers and things. [Uploading the information,] it’s much faster for [the physician.] He was very diligent about getting back to me every so often. I would get an email about my charting. (Clinic 5 Patient)
Similarly, another patient stated that he preferred to upload information on his blood pressure readings instead of playing phone tag with clinic staff to share the information by phone.
One facilitator related to the quality of care and patient safety was that the patient found he thought more about his blood sugar readings because he entered them into a patient portal: “It forces me to look at the numbers as I type them in. … When I do my blood sugar reading, I see it on my meter, but then manually having to enter it also kind of reinforces that” (Clinic 5 Patient).
We identified both facilitators and barriers related to usability. Two patients found the software to be very intuitive and had no trouble learning how to enter readings. However, one patient was not satisfied with the amount of time required to enter the information. She found it “irritating” and time-consuming, compared with her own system of entering data into an Excel spreadsheet. Another barrier was related to finding and opening the application in the patient portal. Two patients found this difficult; both wrote down detailed notes to remind themselves how to do it. Other usability barriers included the fact that the health IT application could not be used on the mobile version of the clinic’s patient portal. One patient would have liked to record changes in her medications so that she could see on the graph how the changes affected her blood pressure readings. Another patient said that the graphing function did not work correctly for readings that were entered in the early morning, because the readings were graphed for the wrong day.
4.3.2.3. Comparison of facilitators and barriers for clinicians and patients. Both providers and patients agree that uploading data into a patient portal is less work for patients and clinic staff, and improves workflow relative to having patients call the clinic to relay the same
Usability barriers to uploading data were primarily on the side of patients. Specifically, data entry is onerous for patients, while the receipt of data by providers is not. Because of the work involved for patients, patient satisfaction with uploading information was fairly low, compared with clinician satisfaction. One patient reported being very satisfied, another reported being slightly satisfied, and the third was dissatisfied. The third patient had stopped using the application because of her “irritation” with usability issues. In contrast, all three providers reported being highly satisfied with the application.
5. Discussion
This study examined three research questions:
1. How does the use of health information technology (IT) to capture and use patient- reported information support or hinder the workflow from the viewpoints of clinicians, office staff, and patients?
2. How does the sociotechnical context influence workflow related to the capture and use of patient-reported information?
3. How do clinics redesign their workflows to incorporate the capture and use of patient- reported information?
In this section we discuss the results with regard to the three research questions across the different health IT applications. There are five clinics that use secure messaging, two clinics that use e-forms, and two clinics that allow patients to use a patient portal to upload information. For the latter two health IT applications, available data are limited.