AMIA2014 Workflow Paper (Monday) Coordination of Care for Complex Pediatric Patients: Perspectives from Providers and Parents

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10:30PM Monday

“Situational awareness

Awareness of activity and communication taking place in a socio-technical system is essential for understanding how events and actions of all agents – human and technological – affect current personal and common objectives and future plans. The design of most EHRs generally does not allow clinicians to maintain this level of activity awareness, especially across different institutions.27
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A physician described updating others on the same care team about planned actions: “After a patient visit I usually talk to their various other providers to make sure we’re all on the same page.” There was no central place to “see the care team and when they want to see the patients next and what the active issues are.” The physician had to recreate the sense of the current state of care from “looking at notes,” a time-consuming task of aggregating and reading through electronic and paper records and emails. Coordination of tasks for very complex patients required in-person meetings and appointments with patients to “go through all of the specialty visits, answer questions, think ahead and troubleshoot any care deficits.”
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Poor situation awareness and event tracking may contribute to adverse events resulting from missing or delayed care. A physician reported that “one of my patients didn’t go to catheterization because they didn’t understand the conversation with the cardiologist and I didn’t know about it, then the patient got hospitalized.” Tracking abnormal radiographs and tests was also seen as a recurring problem with many opportunities for omission.
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Our results correspond with previous reports about inadequate EHR support for team-based chronic care management and that monitoring, plan feedback and assurance that plan components were completed are core requirements for effective coordination.Our model, however, outlines the necessity to integrate non-medical professionals with the care team more closely. We also propose that improvement of EHR design alone can benefit only those clinicians who have access and that bridging communication gaps to care and service providers outside the network may require innovative approaches that integrate several technologies such as web and email-based forms and include interoperable connections between different EHR systems.”

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