Impact of an Organization-Wide Electronic Health Record System on Clinically Integrated Patient CareAbstract: Clinically integrated care delivery is a major goal of health care organizations, focused on the horizontal process of care across entities and time. We constructed a 4-stage model based on the literature to conceptualize in broad terms how health care systems in the United States have adopted integration, moving from vertical integration that brings different health care entities into the same organization to technical integration using the same organization-wide electronic health record (EHR) system across the disparate entities in a system. Clinical integration is enabled by technical integration, but few studies have examined the organizational dynamics by which this occurs. This research explored the effects of an organization-wide EHR on clinical integration through an affordance-actualization lens, centered on Primary Care perspectives. We carried out our research at a large health care system that had recently implemented the Epic EHR system organization wide. Using an IRB-approved protocol, we interviewed 10 Primary Care Physicians (PCPs) in 2019–2020, with a second round of interviews conducted in 2022 with 7 of the same PCPs. Using grounded theory, we explored the effects of the EHR on communication, on care coordination, and on physician engagement. We also identified themes that broadly reflected PCPs experiences using the EHR, capturing enablers and challenges at environmental and individual levels. Our analysis identified that overall, the PCPs interviewed found the organization-wide EHR offered value and required thinking like a system. The EHR gave them a voice in proactively communicating care plans and rationale. PCPs found that integration supported improved communication and were enthusiastic about the use of Epic Secure Chat to directly address patient care issues requiring rapid response. They considered their role as the “Grand Coordinator” of care, supporting care teams with greater access to patient information as well an as ability to manage urgent patient needs. In terms of engagement, PCPs used EHR features to change care and appreciated the connectedness afforded through use of the EHR. Challenges included different practice cultures, information overload, varying clarity of communications, noise in the system from reminders, distribution of duplicate information, additional workload, and frustrations with EHR usability. Based on these findings and the literature, we used an affordance-actualization lens to investigate harnessing technical integration to accelerate clinical integration. We identified five affordances including (1) accessing and using patient data through a unified data source, (2) visualizing system requirements and patient needs, (3) facilitating provider to provider communication, (4) engaging primary care physicians throughout a health care system, and (5) coordinating care across providers and site. Each affordance was examined related to its existence, actualization, and expected outcome. Our work contributes to the literature by introducing the engagement affordance, and presenting dependencies and drivers that enable the actualization of clinical integration through care coordination. Another contribution from our analysis is practical insights that can inform the implementation of an organization-wide EHR to facilitate movement towards clinical integration. Dissertation Committee: Prof. Sharon Johnson (Chair) |
July 19, 2023 (Wednesday) 10:00 AM – 12:00 PM https://wpi.zoom.us/j/92239523844 Amy M. Finn Amy is a part-time Ph.D. candidate in Business Administration, with a focus in Operations Management. Her research interests center strategically and operationally on process transformation and improvement of business practices across industries, specializing in the health care field. Amy has significant experience working in pre- and post-IPO high technology companies and health care organizations. She currently works in the medical device industry, in clinical strategy. Amy has managed multiple large technology and health care transformation programs, including transitions of care and ambulatory care management models. This rich experience contributes unique insights to her research. Amy holds a dual baccalaureate in Bacteriology and English from UCLA, a Pharm.D. from USC, a Ph.D. in Pharmaceutical Chemistry from UC San Francisco Medical Center, two Post Doctoral Fellowships in Clinical and Experimental Pharmacology, an MBA from WPI (Class of 2009), and a Master’s in Public Health (MPH) from UMass Medical School/UMass Amherst. She has extensive knowledge of program management, process and performance improvement, and Agile Scrum. Amy has been an author on multiple technical publications, book chapters, and white papers. Contact: amfinn@wpi.edu |