Obstacles Experienced by Care Managers in Managing Information for the Care of Chronically Ill Patients

ABSTRACT

Care managers play a key role in coordinating care, especially for patients with chronic conditions. They use multiple health information technology (IT) applications in order to access, process, and communicate patient-related information. Using the work system model and its extension, the Systems Engineering Initiative for Patient Safety (SEIPS) model, we describe obstacles experienced by care managers in managing patient-related information. A web-based questionnaire was used to collect data from 80 care managers (61% response rate) located in clinics, hospitals, and a call center. Care managers were more likely to consider “inefficiencies in access to patient-related information” and “having to use multiple information systems” as major obstacles than “lack of computer training and support” and “inefficient use of case management software.” Care managers who reported “inefficient use of case management software” as an obstacle were more likely to report high workload. Future research should explore strategies used by care managers to address obstacles, and efforts should be targeted at improving the health information technologies used by care managers.

Funding

Funding for this research was provided by the US Office of the National Coordinator through the Beacon award program [award No. 90BC001301]. This research was also supported by the Clinical and Translational Science Award (CTSA) program, National Center for Advancing Translational Sciences (NCATS), grant UL1TR000427. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Notes

¹ A chronic condition is “a condition that lasts 12 months or longer and meets one or both of the following tests: (a) it places limitations on self-care, independent living, and social interactions, and/or (b) it results in the need for ongoing intervention with medical products, services, and special equipment.” AHRQ (2011).

² HIE is “the electronic sharing of health-related information according to nationally recognized standards for inter-operability, privacy, and data security” The National Alliance for Health Information Technology (2008).

Additional information

Funding

Funding for this research was provided by the US Office of the National Coordinator through the Beacon award program [award No. 90BC001301]. This research was also supported by the Clinical and Translational Science Award (CTSA) program, National Center for Advancing Translational Sciences (NCATS), grant UL1TR000427. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Notes on contributors

Bashar Alyousef

Bashar Alyousef is Member of Technical Staff at the ZFS Storage Appliance Quality and Systems Engineering Organization, Oracle. He earned his PhD while working as a Research Assistant at UW-Madison Center for Quality and Productivity Improvement. His research applies human factors engineering to health information technology, quality of care, and patient safety.

Pascale Carayon

Pascale Carayon is Procter & Gamble Bascom Professor in Total Quality, Department of Industrial & Systems Engineering and Director of the Center for Quality and Productivity Improvement, University of Wisconsin-Madison. She pioneered the Systems Engineering Initiative for Patient Safety, received the 2015 John M. Eisenberg Patient Safety and Quality Individual Achievement Award, and is a fellow of the Human Factors & Ergonomics Society and the International Ergonomics Association.

Peter Hoonakker

Peter Hoonakker is Senior Scientist and Associate Director of Research of the University of Wisconsin-Madison Center for Quality and Productivity. His research focuses on the impact of health information technology implementation on patient safety and quality of care.

Ann Schoofs Hundt

Ann Schoofs Hundt is Research Scientist and Associate Director of the University of Wisconsin-Madison Center for Quality and Productivity. Her research applies Human Factors and Healthcare Systems Engineering to patient safety. She earned her PhD at UW-Madison, after serving as director of Medical Records and Quality Assurance at UW Hospital and Clinics.

Doreen Salek

Doreen Salek is Senior Director, Care Management/Utilization in the Department of Population Health at Geisinger Health System. Ms. Salek is a registered nurse and has worked at Geisinger as an ICU nurse anddirector of case management. In her current role she focuses on transitions of care, strategies for reducing readmissions and innovations, such as telemonitoring and informatics.

Janet Tomcavage

Janet Tomcavage is the Chief Population Health Officer for Geisinger Health System. In this role, she has administrative accountability for Geisinger’s population health strategies and solution implementation across the clinical and health plan platforms.Ms. Tomcavage earned her bachelor of science in nursing from Bloomsburg State University and her master of science in nursing from College Misericordia.