AHRQ Study Finds Implementing HIT-Enabled Care Coordination Creates Mixed Impact on Workflow in Ambulatory Care Settings

In an AHRQ report from June 2015 prepared by RTI International, Dr. Wald and colleagues qualitatively studied how HIT-enabled care coordination impacted workflow in six ambulatory care clinics with a view towards developing recommendations for efficient redesign. Over a one year period, researchers employed direct observation, staff interviews, software monitoring, and other modes of data collection at six site teams in different phases of implementing the My Health Team at Vanderbilt (MHTAV), a care coordination program with a new care coordinator (CC) and new HIT tools (MHT).

Results found a great deal of variation on the impact in care coordination arising from the use of MHT tools, depending on the specific task, technology, user, and use of HIT within the MHTAV program. Some key points to illustrate the variability of impact and the significance of cultural, physical, policy, and social environments include: 

  • IT impact on CC workflow is dependent on the location of the CC relative to the provider team (i.e. collocated compared to located on a different floor).
  • Certain types of patient information gathering were easy, whereas other types, such as scanned document sharing from other systems was difficult.
  • Enrollment into the MHTAV program via CC calls to patient’s strengthened relationships, but later automatic enrollment based on clinical thresholds weakened the CC-patient relationships.
  • Clinical messaging between the provider (through the EHR) and patient (through the patient portal) was useful, but often did not help facilitate communication between the CC and patient.
  • Improvements in the impact on workflow happened over time as the CC reacted to the technology at hand.
  • Providing greater transparency, by showing all members of the care team the MHT tools utilized by the CC, improved understanding and appreciation of the role offered by the CC. 

For further information on workflow management see the HIMSS ME-PI Toolkit.