TN ambulatory care facilities ‘HIT’ care coordination in the right direction

The impact of health information technology (HIT) on care coordination of ambulatory care in Tennessee was mixed, according to a report from the Agency for Healthcare Research and Quality. The AHRQ report examined how well workflow and HIT were aligned in the context of comprehensive care coordination programs for ambulatory primary care in six Tennessee clinics. The study specifically examined the impact of My Health Team At Vanderbilt (MHTAV), a care coordination program that includes a care coordinator (CC) and HIT components called the My Health Team (MHT) tool. Although the study indicated that work remains to be done, the AHRQ report suggests that HIT can be used with great success in the context of care coordination.

Method

To determine the impact of HIT and MHTAV on care coordination, the study looked at seven specific activities carried out by CCs at the six Tennessee facilities. The activities included: (1) the establishment and maintenance of patient relationships; (2) developing a plan of care (POC); (3) collecting and analyzing home monitoring data; (4) educating patients; (5) coordinating with other staff and patients; (6) searching for information to support coordination decision making; and (7) prioritizing tasks and planning. The AHRQ considered multiple forms of HIT including software specifically developed to support care coordination and existing HIT, which encompassed electronic health records (EHR), patient portals, online patient education materials, messaging, online whiteboards, and scheduling systems. A determination of the impacts of specific HIT on particular activities was gathered through 24 staff interviews and surveys, 40 on-site team observations, 57 patient interviews and surveys, and 14 months of utilization data.

Results

The evaluation revealed that the impact of HIT on care coordination was mixed overall and alignment was “impacted by a variety of software, workflow, and contextual factors.” The findings indicated that cultural, physical, policy, and social environment played an important role in deciding the success of HIT workflow interactions. In some cases, workflow tools that were successful in one area served as a hindrance in another. For example, while POC tools were helpful for CCs, POCs also tended to lack a space for documenting modifications to the plan. EHRs and the patient portal also presented a mixed effectiveness by enhancing provider communications with patients but not necessarily improving connections between CCs and patients. However, AHRQ interpreted the findings to show that due to the complexity of care coordination in an ambulatory care setting, HIT, if implemented correctly, can be used with great success to address the unique and changing issues presented by care coordination.

Room for improvement

Opportunities to increase the impact of HIT were also pointed out by the AHRQ report. Specifically, the findings indicated that adoption of the MHTAV program would be more successful if the MHT tools were aimed at all care team members and not just the CC so that the CC role would be better understood, transparency would improve, and work duplication would be decreased. The report also calls for more research on the impacts of HIT on care coordination to assist the daily activities of “technology designers, program leadership, and those who perform the daily activities of care coordination.”