Towards collaborative-oriented health IT systems design

Abstract

Summary form only given. As the field of healthcare accelerates into the digital age, patient care is increasingly mediated and enabled by ICT systems. With the wide adoption of large-scale information infrastructure, such as Electronic Health Records (EHR), in healthcare organizations, and the use of various patients care technologies deployed in homes and communities settings, health practitioners and consumers are able to make informed decisions based on readily available patient care information. US policy-makers have publicly touted revolutionizing future healthcare through the use of EHR systems [1], since these systems allow evidence-based practices, and foster various record-based research and administration activities. Nevertheless, prior studies have shown that these potential benefits are often compromised by the ineffective design of health IT systems [2], especially when the designs are not properly aligned with the practices of the real patient care.Despite having been originally designed as record-keeping tools, many health IT systems have now become central infrastructures hosting collaboration and communication activity - an essential part of health practices. Patient care work is highly distributed among multiple stakeholders across different locations, such as the home, community and various clinics, over different periods of time [3]. These stakeholders, on one hand, jointly document and use patient care information; and, on the other, constantly articulate and communicate patient-specific information in achieving collaborative work. However, as previous research has shown, a lack of understanding and consideration of what constitutes effective collaborative work across temporal-spatial boundaries often lead to inefficiencies, communication breakdowns, and even medical errors in using health IT systems [e.g. 4, 5]. This talk attempts to address one central research question - how can EHR systems be designed to support collaborative work practices? Drawn on insights obtained from my recent field studies on the adoption, adaptation and appropriation of EHR, PHR and other patient care systems in a variety of clinical and home settings, I will describe the challenges and opportunities identified in designing medical records systems that are aligned with collaborative-nature of work practices [5, 6, 7, 8]. In particular, this talk aims to address the following questions: a) How can health IT systems be designed to mediate work practices conducted by heterogeneous stakeholders at different temporal-spatial points of care?; b) How can informational awareness be provided in collaborative work processes without causing distraction in health providers' workflows?; c) How can team-based information practices be supported while the boundaries of teams are dynamically changing in the patient care process?; d) How can the tensions between providers who are the producer of the patient care information, and the administrators, researchers and policy-makers who are the consumers of the documented information be balanced?; e) and How can health information generated outside of the clinical setting be integrated into the patient record, and engage health consumers as active collaborators in the care process? Addressing these questions is crucial to the design of collaborative-oriented health IT systems, and is key to the overall quality and safety of patient care. The proper design of collaborative-oriented health IT systems can also benefit many patient care systems that are connected to the use of digital patient records, such as telehealth applications for remote medial consultation, mHealth devices for health maintenance, and PHRs for patient engagement.