title: A qualitative evaluation of the crucial attributes of contextual information necessary in EHR design to support patient-centered medical home care.
abstract: BACKGROUND
  Effective implementation of a Primary Care Medical Home model of care (PCMH) requires integration of patients' contextual information (physical, mental, social and financial status) into an easily retrievable information source for the healthcare team and clinical decision-making. This project explored clinicians' perceptions about important attributes of contextual information for clinical decision-making, how contextual information is expressed in CPRS clinical documentation as well as how clinicians in a highly computerized environment manage information flow related to these areas.
  
  
  METHODS
  A qualitative design using Cognitive Task Analyses and a modified Critical Incident Technique were used. The study was conducted in a large VA with a fully implemented EHR located in the western United States. Seventeen providers working in a PCMH model of care in Primary Care, Home Based Care and Geriatrics reported on a recent difficult transition requiring contextual information for decision-making. The transcribed interviews were qualitatively analyzed for thematic development related to contextual information using an iterative process and multiple reviewers with ATLAS@ti software.
  
  
  RESULTS
  Six overarching themes emerged as attributes of contextual information: Informativeness, goal language, temporality, source attribution, retrieval effort, and information quality.
  
  
  CONCLUSIONS
  These results indicate that specific attributes are needed to in order for contextual information to fully support clinical decision-making in a Medical Home care delivery environment. Improved EHR designs are needed for ease of contextual information access, displaying linkages across time and settings, and explicit linkages to both clinician and patient goals. Implications relevant to providers' information needs, team functioning and EHR design are discussed.
authors.affiliation: VA HSR&D Informatics and Decision Enhancement Center of Innovation (IDEAS), 500 Foothill Blvd, Salt Lake City, UT, 84108, USA. Charlene.weir@utah.edu.|Department of Biomedical Informatics, School of Medicine, University of Utah, Suite 208, 421 Wakara Way, Salt Lake City, 84108, UT, USA. Charlene.weir@utah.edu.
authors.forename: Charlene R
authors.initials: CR
authors.lastname: Weir
authors.affiliation: School of Nursing, University of Maryland, 522 West Lombard Street, Baltimore, MD 21201, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Staggers
authors.affiliation: VA HSR&D Informatics and Decision Enhancement Center of Innovation (IDEAS), 500 Foothill Blvd, Salt Lake City, UT, 84108, USA.|Division of Epidemiology, School of Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, Utah, 84132, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Gibson
authors.affiliation: Department of Biomedical Informatics, School of Medicine, University of Utah, Suite 208, 421 Wakara Way, Salt Lake City, 84108, UT, USA.
authors.forename: Kristina
authors.initials: K
authors.lastname: Doing-Harris
authors.affiliation: VA HSR&D Informatics and Decision Enhancement Center of Innovation (IDEAS), 500 Foothill Blvd, Salt Lake City, UT, 84108, USA.
authors.forename: Robyn
authors.initials: R
authors.lastname: Barrus
authors.affiliation: Department of Biomedical Informatics, School of Medicine, University of Utah, Suite 208, 421 Wakara Way, Salt Lake City, 84108, UT, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Dunlea
mesh_terms: D000328:Adult; D000066491:Clinical Decision-Making / Q000379:methods*; D057286:Electronic Health Records / Q000458:organization & administration*; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D057240:Patient Preference; D018802:Patient-Centered Care / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research; D013647:Task Performance and Analysis