Can relational coordination help inter-organizational networks overcome challenges to coordination in patient portals?

Purpose: Delivering comprehensive patient portals in fragmented delivery systems depends on coordination among a network of healthcare organizations. Inter-organizational coordination is fraught with challenges, mainly due to a lack of organizational, technological, and geographical proximity between network participants. This paper assesses the extent to which application of Relational Coordination Theory (RCT) can ameliorate these challenges. Approach: We conducted a conceptual analysis of the usefulness of RCT and the applicability of the Relational Model of Organizational Change to patient portal networks. Findings: Relational coordination can mitigate challenges caused by lack of organizational and technological proximity among participants in a patient portal network. The Relational Model of Organizational Change is useful to improve relational coordination. However, some organization redesign interventions proposed in the Model may not be directly applicable to patient portal networks due to lack of geographical proximity among network participants. Conclusion: We suggest three propositions regarding the relationships among relational coordination, organizational and technological proximity, and cost of coordination in an inter-organizational portal network. If future research provides empirical support for these propositions and identifies appropriate adaptations of the Relational Model of Organizational Change for inter-organizational contexts, portal network leaders should strive to strengthen relational coordination in their networks

Characterization and Representation of Patient Use of Virtual Health Technology in Primary Care

Purpose. Advances in virtual care technology have made healthcare more convenient and accessible. The goal of this study was to elucidate current patient portal behaviors by examining the pattern of time and service type use of patients, via data provided by access logs within electronic health records, to increase communication and care coordination through online healthcare portals. Methods. We conducted a retrospective study of patients in an academic healthcare center over a 5-year period using access log records in electronic health records (EHR). Dimensionality reduction analysis was applied to group portal functionalities into more interpretable and meaningful feature domains, followed by negative binomial regression analysis to evaluate how patient and practice characteristics affected the use of each feature domain. Results. Patient portal usage was categorized into four feature domains: messaging, health information management, billing/insurance, and resource/education. Individuals having more chronic conditions, lab tests or prescriptions generally had greater patient portal usage. However, patients who were male, elderly, in minority groups, or living in rural areas persistently had lower portal usage. Individuals on public insurance were also less likely than those on commercial insurance to use patient portals, though Medicare patients showed greater portal usage on health information management features and uninsured patients had greater usage on viewing resource/education features. Having Internet access only affected the use of messaging features, but not other feature. Conclusions. Efforts in enrolling patients in online portals does not guarantee patients using the portals to manage their health. While promoting the use of virtual health tools as part of patient-center care delivery model, primary care clinicians need to be aware of technological, socioeconomic, and cultural challenges faced by their patients

Patient portals

Patient portals can give patients access to a personal health record and enable interaction with the health care system. Patient portals are creating unprecedented opportunities for using health IT to deliver care to patients, paving the way for benefits to patients, providers and the organizations that implement the portals. The objective of this dissertation has been to explore the role of the organizational context by identifying and describing factors affecting portals in different types of health service systems. We have let the following four questions guide the research. 1. What outcomes have been achieved through patient portals and how are these outcomes achieved? 2. How does the health service system context, in particular health service system integration or fragmentation, impact patient portal development and ability to achieve beneficial outcomes? 3. With focus on fragmented health service systems, how can patient portal development and achievement of beneficial outcomes be improved? 4. How can the existing evidence base inform patient portal development across health service systems and how can this evidence base be advanced? In answering these questions, we studied portals in integrated and fragmented health service systems in the United States and in the Netherlands. We relied on multiple qualitative methods, including literature review, document analysis, and interviews

Plug-in healthcare:Development, ruination, and repair in health information exchange

This dissertation explores the work done by people and things in emerging infrastructures for health information exchange. It shows how this work relates to processes of development, production, and growth, as well as to abandonment, ruination, and loss. It argues for a revaluation of repair work: a form of articulation work that attends to gaps and disruptions in the margins of technological development. Often ignored by engineers, policy makers, and researchers, repair sensitizes us to different ways of caring for people and things that do not fit, fall in between categories, and resist social norms and conventions. It reminds us that infrastructures emerge in messy and unevenly distributed sociotechnical configurations, and that technological solutions cannot be simply ‘plugged in’ at will, but require all kinds of work. With that, repair emphasizes the need for more democratic, critical, and reflexive engagements with (and interventions in) health information exchange. Empirically, this study aims to understand how ‘integration’ in health information exchange is done in practice, and to develop concepts and insights that may help us to rethink technological development accordingly. It starts from the premise that the introduction of IT in healthcare is all too often regarded as a neutral process, and as a rational implementation challenge. These widespread views among professionals, managers, and policy makers need to be addressed, as they have very real – and mostly undesirable – consequences. Spanning a period of more than ten years, this study traces the birth and demise of an online regional health portal in the Netherlands (2009-2019). Combining ethnographic research with an experimental form of archive work, it describes sociotechnical networks that expanded, collapsed, and reconfigured around a variety of problems – from access to information and data ownership to business cases, financial sustainability, and regional care. It puts a spotlight on the integration of standards, infrastructures, and users in the portal project, and on elements of collapsing networks that quietly resurfaced elsewhere. The reconstruction of these processes foregrounds different instances of repair work in the portal’s development and subsequent abandonment, repurposing, and erasure. Conceptually, this study contributes to academic debates in health information exchange, including the politics of technology, practices of participatory design, and the role of language in emerging information infrastructures. It latches on to ethnographic studies on information systems and infrastructural work, and brings together insights from actor-network theory, science and technology studies, and figurational sociology to rethink and extend current (reflexive and critical) understandings of technological development. It raises three questions: What work is done in the development and demise of an online health portal? How are relations between people and things shaped in that process? And how can insights from this study help us to understand changing sociotechnical figurations in health information exchange? The final analysis includes five key concepts: the act of building network extensions, the method of tracing phantom networks, the notion of sociotechnical figurations, the logic of plug-in healthcare, and repair as a heuristic device.<br/

Towards quality indicators for health care for people with Down syndrome, and beyond

Down syndrome (DS) is related to intellectual disability and a combination of behavioural patterns and physical health problems. As a result of this, people with DS are reliant on a large variety of supports and services. Health care services are one of these. Because of their specific health care needs, high quality health care for people with DS is vital. Quality indicators (QIs) can contribute to this quality. QIs are measurable and carefully defined items of health care that provide insight into health care quality. QIs may identify directions for health care reforms, inform clinical decisions, and help patients finding the needed care. However, QIs providing insight into health care for people with DS are still to be developed. This doctoral thesis provides an empirical basis and a first draft of such QIs. It also gives practical recommendations for the further development and actual use of the QIs. The thesis is based on literature study, semi-structured interviews involving people with DS and their parents, focus groups with support staff working in assisted living facilities, and a consensus method (Delphi study) involving health care professionals and patient organisations. This resulted in 46 potential QIs, grouped into three main quality dimensions: Effectiveness (e.g. adequate and timely treatment of health problems), Organisation of care (e.g. coordination, continuity and accessibility), and Person-centredness (e.g. personal preferences and abilities are taken into account). Additionally, the thesis reflects on the meaningfulness of such QIs for health care specifically for people with DS, but also for other people with complex needs and the general population. The thesis also puts the QIs in a wider perspective: in the context in which people with DS live, and in the context of (integrated) health care systems. The thesis concludes that QIs providing insight into the mentioned quality dimensions are important for improving health care for people with DS. However, the actual use of QIs may be hampered by registrational burden, and the extent to which quality information is made public should be carefully balanced. Furthermore, it is noted that not only QIs, but also additional innovations, within and outside health care, may contribute to making a change in the lives of people with DS