CHS: Small: Understanding how health information technology mediates collaborative reflection within care teams

Regents Of The University Of Michigan - Ann Arbor, Ann Arbor MI

Investigators

Abstract

This research will develop cyber-human systems design principles grounded in empirical and user-centered methods to guide the development and implementation of health information technology systems that have a positive effect on team-based collaboration. The delivery of healthcare services is changing in response to an increase in chronic conditions. Care is provided by teams often distributed across agencies, rather than by a single physician. The collaboration of a care team has also been extended to include active involvement of patients themselves, home caregivers, and community organizations. Integrating care that spans time, providers, and agencies is a growing challenge that exacerbates barriers to communication and collaboration. Despite its promise, health information technology (HIT) often fails to enhance distributed collaboration over time. Current methods and tools, including electronic health records, do not adequately support collaboration because they become passive information repositories, which do not inform distributed, collaborative reflection and decision-making for chronic care. This research leverages prior work that (1) generated the framework of collaborative reflection, and (2) prototyped and piloted a novel HIT system named Lilypad, designed to support collaborative reflection within behavioral health. The three aims of this research are: (1) to understand instances when the process of collaborative reflection breaks down and care advances without reliance on data or inclusion of multiple perspectives from across the care team, (2) to identify potential unintended consequences of HIT-mediated collaborative reflection, and (3) to generate empirically-based design principles for HIT that promotes collaborative reflection. Based on the promising results of exploratory studies, a long-term deployment study will investigate the use of the prototype across organizational boundaries. The first year will engage care teams in participatory design to tailor it for their needs and facilitate a transition to its use. Then, over two years of use, data will be triangulated from a range of methods, including: interviews to gather individual participant attitudes, observation of care team collaboration via use and non-use, and monitoring of usage logs. A sociotechnical study of Lilypad use will provide insight into how novel HIT systems can mediate collaborative reflection. In addition, this study will contribute to literature on unintended negative consequences of HIT use, and provide design and implementation guidelines for moderating these effects. This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.