A framework for information system usage in collaborative care.
Clinical information systems (CIS) can affect the quality of patient care. In this paper, we focus on CIS use in the collaborative treatment of chronic diseases. We have developed a framework to determine which CIS functions have general usefulness for improving patient outcomes.


METHODS
We reviewed the use of clinical information systems within a collaborative care environment, identifying CIS functions important in chronic disease care. We grouped the functions into categories of access, best practices, and communication (ABC). Three independent raters selected the most important collaborative care related functions from the HL7 Electronic Health Record Systems functional model, and mapped the HL7 functions against the ABC categories. We then built a model of CIS use and tested it on data from a cohort of patients with chronic illnesses.


RESULTS
Of the 133 HL7 elements in the ABC model, 60 (45%) were ranked as important for collaborative care by two reviewers. Agreement was moderate for importance (kappa=.20) but high for ABC categorization (kappa=.67). In our data tests, for the 1105 patients, access 4.4+/-6.5, best practices 0.8+/-1.6, and communication 2.9+/-4.5. CIS functions were used per episode of care. We were able to identify several key functions that may affect patient care. For example, certain CIS functions related to best practices were associated with higher clinician adherence to testing guidelines.


CONCLUSIONS
This framework may be useful to assess and compare CIS systems for collaborative care. Future refinements of the model are discussed.
Dorr
David A
DA
Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, USA. dorrd@ohsu.edu
Jones
Spencer S
SS
Wilcox
Adam
A
D002908:Chronic Disease / Q000628:therapy; D015331:Cohort Studies; D003299:Cooperative Behavior; D003661:Decision Support Techniques; D003695:Delivery of Health Care / Q000379:methods*; D006751:Hospital Information Systems; D006761:Hospitals; D006801:Humans; D033183:Interdisciplinary Communication; D007400:Interprofessional Relations; D016347:Medical Records Systems, Computerized; D017146:Models, Organizational; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D012984:Software; D014589:Utah