TY - JOUR
KW - Aged
KW - Community Health Services/organization & administration
KW - Delivery of Health Care, Integrated/standards
KW - Humans
KW - Information Systems
KW - New Zealand
KW - Ontario
KW - Organizational Innovation
KW - Primary Health Care/organization & administration
KW - Quebec
KW - Work Simplification
KW - Chronic illnesses
KW - disruptive innovation
KW - Health Information Technology
KW - implementation
KW - Integrated Health Care Systems
KW - Multi-morbidity
AU - Carolyn Steele Gray
AU - Jan Barnsley
AU - Dominique Gagnon
AU - Louise Belzile
AU - Tim Kenealy
AU - James Shaw
AU - Nicolette Sheridan
AU - Paul Wankah Nji
AU - Walter P. Wodchis
A1 - 
AB - BACKGROUND: Information communication technology (ICT) is a critical enabler of integrated models of community-based primary health care; however, little is known about how existing technologies have been used to support new models of integrated care. To address this gap, we draw on data from an international study of integrated models, exploring how ICT is used to support activities of integrated care and the organizational and environmental barriers and enablers to its adoption. METHODS: We take an embedded comparative multiple-case study approach using data from a study of implementation of nine models of integrated community-based primary health care, the Implementing Integrated Care for Older Adults with Complex Health Needs (iCOACH) study. Six cases from Canada, three each in Ontario and Quebec, and three in New Zealand, were studied. As part of the case studies, interviews were conducted with managers and front-line health care providers from February 2015 to March 2017. A qualitative descriptive approach was used to code data from 137 interviews and generate word tables to guide analysis. RESULTS: Despite different models and contexts, we found strikingly similar accounts of the types of activities supported through ICT systems in each of the cases. ICT systems were used most frequently to support activities like care coordination by inter-professional teams through information sharing. However, providers were limited in their ability to efficiently share patient data due to data access issues across organizational and professional boundaries and due to system functionality limitations, such as a lack of interoperability. CONCLUSIONS: Even in innovative models of care, managers and providers in our cases mainly use technology to enable traditional ways of working. Technology limitations prevent more innovative uses of technology that could support disruption necessary to improve care delivery. We argue the barriers to more innovative use of technology are linked to three factors: (1) information access barriers, (2) limited functionality of available technology, and (3) organizational and provider inertia.
AD - Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 1 Bridgepoint Drive, Toronto, M4M 2B5, Canada. Carolyn.SteeleGray@sinaihealthsystem.ca.; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St., Toronto, Ontario, M5T 3M6, Canada. Carolyn.SteeleGray@sinaihealthsystem.ca.; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St., Toronto, Ontario, M5T 3M6, Canada.; Unite d'enseignement et de recherche en sciences du developpement humain et social, Universite du Quebec en Abitibi-Temiscamingue, Val-d'Or, Canada.; Gerontology, Universite de Sherbrooke, Sherbrooke, Canada.; South Auckland Clinical School, University of Auckland, Auckland, New Zealand.; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St., Toronto, Ontario, M5T 3M6, Canada.; Institute for Health System Solutions and Virtual Care, Women's College Research Institute, Women's College Hospital, Toronto, Canada.; Centre for Nursing and Health Research, School of Nursing, College of Health Te Kura Hauora Tengata, Massey University, Wellington, New Zealand.; Sciences de la Sante, Centre de Recherche-Hopital Charles LeMoyne, Universite de Sherbrooke-Campus Longueuil, Longueuil, Canada.; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St., Toronto, Ontario, M5T 3M6, Canada.; Implementation and Evaluation Science, Institute for Better Health, Trillium Health Partners, Mississauga, Canada.
BT - Implementation science : IS
C5 - Education & Workforce; Healthcare Disparities; HIT & Telehealth
CP - 1
CY - England
DO - 10.1186/s13012-018-0780-3
IS - 1
JF - Implementation science : IS
LA - eng
M1 - Journal Article
N2 - BACKGROUND: Information communication technology (ICT) is a critical enabler of integrated models of community-based primary health care; however, little is known about how existing technologies have been used to support new models of integrated care. To address this gap, we draw on data from an international study of integrated models, exploring how ICT is used to support activities of integrated care and the organizational and environmental barriers and enablers to its adoption. METHODS: We take an embedded comparative multiple-case study approach using data from a study of implementation of nine models of integrated community-based primary health care, the Implementing Integrated Care for Older Adults with Complex Health Needs (iCOACH) study. Six cases from Canada, three each in Ontario and Quebec, and three in New Zealand, were studied. As part of the case studies, interviews were conducted with managers and front-line health care providers from February 2015 to March 2017. A qualitative descriptive approach was used to code data from 137 interviews and generate word tables to guide analysis. RESULTS: Despite different models and contexts, we found strikingly similar accounts of the types of activities supported through ICT systems in each of the cases. ICT systems were used most frequently to support activities like care coordination by inter-professional teams through information sharing. However, providers were limited in their ability to efficiently share patient data due to data access issues across organizational and professional boundaries and due to system functionality limitations, such as a lack of interoperability. CONCLUSIONS: Even in innovative models of care, managers and providers in our cases mainly use technology to enable traditional ways of working. Technology limitations prevent more innovative uses of technology that could support disruption necessary to improve care delivery. We argue the barriers to more innovative use of technology are linked to three factors: (1) information access barriers, (2) limited functionality of available technology, and (3) organizational and provider inertia.
PP - England
PY - 2018
SN - 1748-5908; 1748-5908
SP - 87
T1 - Using information communication technology in models of integrated community-based primary health care: learning from the iCOACH case studies
T2 - Implementation science : IS
TI - Using information communication technology in models of integrated community-based primary health care: learning from the iCOACH case studies
U1 - Education & Workforce; Healthcare Disparities; HIT & Telehealth
U2 - 29940992
U3 - 10.1186/s13012-018-0780-3
VL - 13
VO - 1748-5908; 1748-5908
Y1 - 2018
Y2 - Jun 26
ER -