Hans Parminder K, Gray Carolyn Steele, Gill Ashlinder, Tiessen James
1Bridgepoint Collaboratory,Lunenfeld-Tanenbaum Research Institute,Sinai Health System,Toronto,ON,Canada.
2Institute for Health Policy, Management and Evaluation,Dalla Lana School of Public Health,University of Toronto,Toronto,ON,Canada.
Prim Health Care Res Dev. 2018 Mar;19(2):151-164. doi: 10.1017/S1463423617000573. Epub 2017 Sep 13.
Aim This qualitative study investigates how the Electronic Patient-Reported Outcome (ePRO) mobile application and portal system, designed to capture patient-reported measures to support self-management, affected primary care provider workflows.
The Canadian health system is facing an ageing population that is living with chronic disease. Disruptive innovations like mobile health technologies can help to support health system transformation needed to better meet the multifaceted needs of the complex care patient. However, there are challenges with implementing these technologies in primary care settings, in particular the effect on primary care provider workflows.
Over a six-week period interdisciplinary primary care providers (n=6) and their complex care patients (n=12), used the ePRO mobile application and portal to collaboratively goal-set, manage care plans, and support self-management using patient-reported measures. Secondary thematic analysis of focus groups, training sessions, and issue tracker reports captured user experiences at a Toronto area Family Health Team from October 2014 to January 2015. Findings Key issues raised by providers included: liability concerns associated with remote monitoring, increased documentation activities due to a lack of interoperability between the app and the electronic patient record, increased provider anxiety with regard to the potential for the app to disrupt and infringe upon appointment time, and increased demands for patient engagement. Primary care providers reported the app helped to focus care plans and to begin a collaborative conversation on goal-setting. However, throughout our investigation we found a high level of provider resistance evidenced by consistent attempts to shift the app towards fitting with existing workflows rather than adapting much of their behaviour. As health systems seek innovative and disruptive models to better serve this complex patient population, provider change resistance will need to be addressed. New models and technologies cannot be disruptive in an environment that is resisting change.
目的 本定性研究调查了旨在收集患者报告的措施以支持自我管理的电子患者报告结局（ePRO）移动应用程序和门户系统如何影响初级保健提供者的工作流程。
加拿大卫生系统正面临着患有慢性病的老龄化人口。移动健康技术等颠覆性创新有助于支持卫生系统转型，以更好地满足复杂护理患者的多方面需求。然而，在初级保健环境中实施这些技术存在挑战，特别是对初级保健提供者工作流程的影响。
在六周的时间里，跨学科的初级保健提供者（n = 6）及其复杂护理患者（n = 12）使用ePRO移动应用程序和门户，通过患者报告的措施共同设定目标、管理护理计划并支持自我管理。对焦点小组、培训课程和问题跟踪报告进行二次主题分析，记录了2014年10月至2015年1月在多伦多地区家庭健康团队的用户体验。结果 提供者提出的关键问题包括：与远程监测相关的责任问题、由于应用程序与电子病历之间缺乏互操作性而增加的文档活动、提供者对应用程序可能干扰和侵犯预约时间的焦虑增加，以及对患者参与度的需求增加。初级保健提供者报告称，该应用程序有助于聚焦护理计划并开启关于目标设定的协作对话。然而，在整个调查过程中，我们发现提供者存在高度抵触情绪，表现为不断试图让应用程序适应现有的工作流程，而不是改变他们的大部分行为。随着卫生系统寻求创新和颠覆性模式以更好地服务这一复杂患者群体，需要解决提供者的变革抵触问题。在一个抵制变革的环境中，新模式和技术无法具有颠覆性。
