CHS: Small: Understanding how health information technology mediates collaborative reflection within care teams

这项研究将制定基于经验和以用户为中心的方法的网络-人类系统设计原则，以指导对基于团队的协作具有积极影响的卫生信息技术系统的开发和实施。随着慢性病的增加，医疗保健服务的提供正在发生变化。护理通常由分布在不同机构的团队提供，而不是由一名医生提供。护理团队的合作也已扩展到包括患者本身、家庭护理人员和社区组织的积极参与。整合跨越时间、提供者和机构的护理是一项日益严峻的挑战，加剧了沟通和协作的障碍。尽管医疗信息技术(HIT)前景看好，但随着时间的推移，它往往无法增强分布式协作。目前的方法和工具，包括电子健康记录，不能充分支持协作，因为它们成为被动的信息储存库，不能为慢性护理的分布式、协作性思考和决策提供信息。本研究的三个目的是：(1)建立协作反思的框架，(2)设计并试制一个新的HIT系统Lilypad，用于支持行为健康中的协作反思。本研究的三个目的是：(1)了解协作反思过程中断和护理进展的情况，而不依赖于数据或包含来自护理团队的多个视角；(2)识别HIT中介的协同反思的潜在意外后果；以及(3)为促进协同反思的HIT生成基于经验的设计原则。基于探索性研究的可喜结果，一项长期部署研究将调查原型在组织边界上的使用。第一年将让护理团队参与设计，以适应他们的需求，并促进向使用的过渡。然后，在使用两年后，将从一系列方法中三角测量数据，包括：收集个体参与者态度的访谈，通过使用和不使用观察护理团队协作，以及监控使用日志。一项关于Lilypad使用的社会技术研究将为新的HIT系统如何协调协作反思提供洞察力。此外，这项研究将对使用HIT的意外负面后果的文献做出贡献，并为缓解这些影响提供设计和实施指南。该奖项反映了NSF的法定使命，并通过使用基金会的智力优势和更广泛的影响审查标准进行评估，被认为值得支持。

This research will develop cyber-human systems design principles grounded in empirical and user-centered methods to guide the development and implementation of health information technology systems that have a positive effect on team-based collaboration. The delivery of healthcare services is changing in response to an increase in chronic conditions. Care is provided by teams often distributed across agencies, rather than by a single physician. The collaboration of a care team has also been extended to include active involvement of patients themselves, home caregivers, and community organizations. Integrating care that spans time, providers, and agencies is a growing challenge that exacerbates barriers to communication and collaboration. Despite its promise, health information technology (HIT) often fails to enhance distributed collaboration over time. Current methods and tools, including electronic health records, do not adequately support collaboration because they become passive information repositories, which do not inform distributed, collaborative reflection and decision-making for chronic care. This research leverages prior work that (1) generated the framework of collaborative reflection, and (2) prototyped and piloted a novel HIT system named Lilypad, designed to support collaborative reflection within behavioral health.The three aims of this research are: (1) to understand instances when the process of collaborative reflection breaks down and care advances without reliance on data or inclusion of multiple perspectives from across the care team, (2) to identify potential unintended consequences of HIT-mediated collaborative reflection, and (3) to generate empirically-based design principles for HIT that promotes collaborative reflection. Based on the promising results of exploratory studies, a long-term deployment study will investigate the use of the prototype across organizational boundaries. The first year will engage care teams in participatory design to tailor it for their needs and facilitate a transition to its use. Then, over two years of use, data will be triangulated from a range of methods, including: interviews to gather individual participant attitudes, observation of care team collaboration via use and non-use, and monitoring of usage logs. A sociotechnical study of Lilypad use will provide insight into how novel HIT systems can mediate collaborative reflection. In addition, this study will contribute to literature on unintended negative consequences of HIT use, and provide design and implementation guidelines for moderating these effects.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.