Integrating a health-related-quality-of-life module within electronic health records: a comparative case study assessing value added

<p>Abstract</p> <p>Background</p> <p>Health information technology (HIT) applications that incorporate point-of-care use of health-related quality of life (HRQL) assessments are believed to promote patient-centered interactions between seriously ill patients and physicians. However, it is unclear how willing primary care providers are to use such HRQL HIT applications. The specific aim of this study was to explore factors that providers consider when assessing the value added of an HRQL application for their geriatric patients.</p> <p>Methods</p> <p>Three case studies were developed using the following data sources: baseline surveys with providers and staff, observations of staff and patients, audio recordings of patient-provider interactions, and semi-structured interviews with providers and staff.</p> <p>Results</p> <p>The primary factors providers considered when assessing value added were whether the HRQL information from the module was (1) duplicative of information gathered via other means during the encounter; (2) specific enough to be useful and/or acted upon, and; (3) useful for enough patients to warrant time spent reviewing it for all geriatric patients. Secondary considerations included level of integration of the HRQL and EHR, impact on nursing workflow, and patient reluctance to provide HRQL information.</p> <p>Conclusions</p> <p>Health-related quality of life modules within electronic health record systems offer the potential benefit of improving patient centeredness and quality of care. However, the modules must provide benefits that are substantial and prominent in order for physicians to decide that they are worthwhile and sustainable. Implications of this study for future research include the identification of perceived "costs" as well as a foundation for operationalizing the concept of "usefulness" in the context of such modules. Finally, developers of these modules may need to make their products customizable for practices to account for variation in EHR capabilities and practice workflows.</p

How to bring a technical artifact into use: A micro-developmental perspective

In order to understand how technical artifacts are attuned to, interacted with, and shaped in various and varied classrooms, it is necessary to construct detailed accounts of the use of particular artifacts in particular classrooms. This paper presents a descriptive account of how a shared workspace was brought into use by a student pair in a face-to-face planning task. A micro-developmental perspective was adopted to describe how the pair established a purposeful connection with this unfamiliar artifact over a relatively short time frame. This appropriation was examined against the background of their regular planning practice. We describe how situational resources present in the classroom—norms, practices and artifacts— frame possible action, and how these possibilities are enacted by the pair. Analysis shows that the association of norms and practices with the technical artifact lead to a contradiction that surfaced as resistance experienced from the artifact. This resistance played an important part in the appropriation process of the pair. It signaled tension in the activity, triggered reflection on the interaction with the artifact, and had a coordinative function. The absence of resistance was equally important. It allowed the pair to transpose or depart from regular procedure without reflection