AHRQ: Patient engagement tools both help, hurt clinician workflow

Health IT applications that engage patients can have both a positive and a negative effect on clinicians' workflow, according to a new final contract report funded by the Agency for Healthcare Research and Quality (AHRQ).

The report reviews patient use of secure messaging, electronic forms patients complete on a computer and portals to upload clinical data to their clinicians, and involves six different clinics in medium sized cities.

Other studies have found that while patient interest in online access to their providers is increasing, challenges remain in enticing patients to use electronic methods of patient engagement offered by providers. Portal use, in particular, appears to be mixed.

Secure messaging was found to have the most negative impact on clinicians' workflow. While it provided a new channel for communication and allowed clinicians to respond at more convenient times, it also created barriers, such as inappropriate use by patients, and usability issues.  Electronic forms and portals were more helpful to clinicians and had less negative impact on workflow. However, portals were more helpful for clinicians than patients, many of whom stopped using them.

Other factors also affected the workflow. For instance, the longer a clinic was using secure messaging, the more it impacted workflow, because over time more patients adopted it, increasing the volume of messages received. Clinicians operating as teams, such as patient centered medical homes, had better workflow because the secure messages were triaged by nurses who distributed them to physicians, eliminating the need for physicians to do so personally. Clinicians who used more part time staff had more trouble with patient-reported health IT because staff were less familiar with the technology.

"[T]hese health IT applications may improve process measures, such as greater adherence, better self-care, improved patient-provider communication and patient satisfaction," the report's authors said. "The results of this study support the findings in the literature that patients sharing their information with clinicians electronically can facilitate communication, improve the organization of work, reduce workload and increase patient satisfaction. However, results also show that some of these same dimensions [e.g., amount of work] can be a barrier. In other words: implementation of these health IT applications--in particular, secure messaging--can have benefits, but they can also hinder workflow and, for example, increase physicians' workload.".

To learn more:
- read the report (.pdf)