School of Nursing, Columbia University, New York, NY, United States.
Int J Med Inform. 2012 Oct;81(10):e56-62. doi: 10.1016/j.ijmedinf.2012.07.002. Epub 2012 Jul 28.
Case managers facilitate continuity of care for persons living with HIV (PLWH) by coordination of resources and referrals to social services and medical care. The complexity of HIV care and associated comorbidities drives the need for medical and psychosocial care coordination, which may be achieved through health information exchange (HIE) systems. However, the use of HIE has not been well studied in the context of HIV services. The purpose of this descriptive qualitative study is to explore factors influencing case managers' adoption of electronic clinical data (ECD) summaries as an HIE strategy in HIV care through application of the "fit between individuals, task and technology" (FITT) framework.
Focus group methodology was used to gather perceptions from 48 participants who provided direct case management services for PLWH in New York City. Questions addressed current quality and efficiency challenges to HIE utilization in the context of case management of PLWH as well as barriers and enablers to use of an ECD summary. Analysis of the data was guided by the FITT framework.
Major themes by interaction type were: (1) task-technology fit - resources, time and workflow; (2) individual-task fit - training and technical support; and 3) individual-technology fit - ECD summary functionality, technical difficulties and the need of a computer for each end-user.
Our findings provide evidence for the applicability of the FITT framework to explore case managers' perceptions of factors influencing the adoption of ECD summary systems for HIV care prior to actual implementation. Assessment of fit among individual, task, and technology and addressing the concerns identified prior to implementation is critical to successful adoption of health information technology as a strategy to improve quality and efficiency in health care.
病例管理员通过协调资源并将其转介给社会服务和医疗服务，促进艾滋病毒感染者（PLWH）的护理连续性。HIV 护理的复杂性及其相关合并症促使人们需要进行医疗和心理社会护理协调，而这可以通过健康信息交换（HIE）系统来实现。然而，在 HIV 服务背景下，HIE 的使用尚未得到充分研究。本描述性定性研究的目的是通过应用“个体、任务和技术之间的匹配”（FITT）框架，探讨影响病例管理员采用电子临床数据（ECD）摘要作为 HIV 护理中 HIE 策略的因素。
采用焦点小组方法收集了 48 名参与者的意见，这些参与者在纽约市为 PLWH 提供直接的病例管理服务。这些问题涉及到 HIE 在 PLWH 病例管理中的利用所面临的当前质量和效率挑战，以及使用 ECD 摘要的障碍和促进因素。数据的分析由 FITT 框架指导。
按交互类型划分的主要主题包括：（1）任务-技术匹配 - 资源、时间和工作流程；（2）个体-任务匹配 - 培训和技术支持；以及 3）个体-技术匹配 - ECD 摘要功能、技术困难以及每个最终用户需要计算机。
我们的研究结果为 FITT 框架提供了证据，可用于探索病例管理员对影响采用 HIV 护理 ECD 摘要系统的因素的看法，以便在实际实施之前进行探索。评估个体、任务和技术之间的匹配，并在实施之前解决已确定的问题，对于成功采用健康信息技术作为提高医疗质量和效率的策略至关重要。
