Characteristics of electronic patient-provider messaging system utilisation in an urban health care organisation

Introduction Research suggests that electronic messaging can improve patient engagement. Studies indicate that a ‘digital divide’ may exist, where certain patient populations may be using electronic messaging less frequently. This study aims to determine which patient characteristics are associated with different levels of usage of an electronic patient-provider messaging system in a diverse urban population.Methods Cross-sectional electronic health record data were extracted for patients 10 years of age or older who live in New York City and who visited a set of clinics between 1 July 2011 and 30 June 2012. Regression analyses determined which participant characteristics were associated with the sending of electronic messages.Results Older, female, English-speaking participants of white race who received more messages, had any diagnoses, more office visits and a provider who sent messages were more likely to send more messages. Non-Millennial, non-white participants who received fewer messages, had more office visits, any diagnoses, a provider who saw fewer patients with patient portal accounts, lived in a low socioeconomic status neighbourhood, and did not have private insurance were more likely to send zero messages.Conclusion This study found significant differences in electronic messaging usage based on demographic, socioeconomic and health-related patient characteristics. Future studies are needed to support these results and determine the causes of observed associations

No Wrong Door: Designing Health Information Technology to Support Interprofessional Collaboration Around Child Development Work

Thesis (Ph.D.)--University of Washington, 2018Child development refers to children gaining the skills they need to succeed in life, consisting of abilities in overlapping domains such as speech, motor, social, and cognition. Developmental disabilities are chronic delays in gaining such skills, and if they are not addressed in a timely manner, a child can experience negative outcomes throughout their life. Responsibilities for identifying and treating developmental delays and disabilities are spread across many stakeholders in the community, including not only parents but an interprofessional collection of service providers such as pediatricians, early educators, childcare providers, providers of home visiting services, and community groups. Regardless of who is involved in a child’s care, there must be “no wrong door” into the ecosystem of development support services. Unfortunately, these stakeholders operate in silos, resulting in a fractured system of services that parents struggle to navigate. This often leads to delays in the receipt of necessary services and uncoordinated care. Various researchers and policy leaders, such as the American Academy of Pediatrics, have suggested that health information technology (HIT) could be an important tool to help stakeholders collaborate in a child’s care management. Current biomedical informatics literature, however, provides little practical guidance on how to design HIT systems to support such interprofessional collaboration. This dissertation presents four studies that aim to address this design gap by drawing upon the extensive body of literature on collaborative practice and the user-centered design framework. These studies demonstrate the use of qualitative methods in conjunction with theoretical concepts to assess the needs of a heterogeneous collection of stakeholders in regard to collaborative work with the goal of deriving design implications for future creators of collaborative HIT systems. The first study demonstrates the utility of using concepts from collaboration literature to uncover actionable design implications for collaborative systems using previously collected interview data from an interprofessional collection of stakeholders. The second and third studies utilize the methods of the first study to explore interprofessional work processes and interprofessional trust, respectively, with original interview data. Building upon the third study, the last study provides practical guidance for designing interprofessional collaborative systems to support the creation of trust between stakeholders of heterogeneous backgrounds. This is achieved through eliciting the information that people use to judge trustworthiness, and then creating and testing prototype webpages listing the noted information. This research will provide concrete methodological guidance for designers of future systems to support collaborative work, as well as provide concrete design implications for such systems