title: Examining the Multi-level Fit between Work and Technology in a Secure Messaging Implementation.
abstract: Secure messaging (SM) allows patients to communicate with their providers for non-urgent health issues. Like other health information technologies, the design and implementation of SM should account for workflow to avoid suboptimal outcomes. SM may present unique workflow challenges because patients add a layer of complexity, as they are also direct users of the system. This study explores SM implementation at two Veterans Health Administration facilities. We interviewed twenty-nine members of eight primary care teams using semi-structured interviews. Questions addressed staff opinions about the integration of SM with daily practice, and team members' attitudes and experiences with SM. We describe the clinical workflow for SM, examining complexity and variability. We identified eight workflow issues directly related to efficiency and patient satisfaction, based on an exploration of the technology fit with multilevel factors. These findings inform organizational interventions that will accommodate SM implementation and lead to more patient-centered care.
authors.affiliation: University of Colorado, Aurora, CO.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Ozkaynak
authors.affiliation: Worcester Polytechnic Institute, Worcester, MA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Johnson
authors.affiliation: Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, MA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Shimada
authors.affiliation: Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, MA.
authors.forename: Beth Ann
authors.initials: BA
authors.lastname: Petrakis
authors.affiliation: Worcester Polytechnic Institute, Worcester, MA.
authors.forename: Bengisu
authors.initials: B
authors.lastname: Tulu
authors.affiliation: New England Veterans Engineering Resource Center, Boston, MA.
authors.forename: Cliona
authors.initials: C
authors.lastname: Archambeault
authors.affiliation: Center for Healthcare Organization and Implementation Research (CHOIR), Bedford, MA.
authors.forename: Gemmae
authors.initials: G
authors.lastname: Fix
authors.affiliation: Portland VA Medical Center, Portland, OR.
authors.forename: Erin
authors.initials: E
authors.lastname: Schwartz
authors.affiliation: Portland VA Medical Center, Portland, OR.
authors.forename: Susan
authors.initials: S
authors.lastname: Woods
mesh_terms: D016494:Computer Security; D057286:Electronic Health Records; D034742:Electronic Mail; D006801:Humans; D007407:Interviews as Topic; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D014481:United States; D014493:United States Department of Veterans Affairs; D057188:Workflow