Brandie Steeves, Paul Stolee, Christine Glenny, Stephanie Filsinger, Dharshini Gnanapandithen, Katherine Berg The Use of Electronic Health Information Systems in Rehabilitation of Older Home Care Clients: Facilitators & Barriers Introduction The management and sharing of health information is critically important in home care due to the involvement of multiple health professionals across various settings. Electronic health information systems (EHIS) containing standardized assessment data (e.g., RAI-HC, OASIS) hold considerable promise, but their potential has yet to be fully realized(Marshall et al., 2000; Teare & Weiler, 2003; Zelmer, 2004; Egan et al., submitted). This research is part of a larger study (InfoRehab Home Care) which has two main objectives: a) to create evidence that describes and enhances the role of rehabilitation in home care, by answering key questions identified in previous and planned stakeholder consultations, through analyses of available health information; and b) to improve the understanding and use of health information by administrators, case managers, and service providers involved in home care services. Objective b) is the focus for the literature review and knowledge exchange panels outlined here. This research is guided by the Promoting Action on Research in Health Services (PARiHS) theoretical framework, which illuminates how knowledge moves through social relationships and interactions. It claims that knowledge is mobilized through three key mediators: the nature of the knowledge or evidence [E], the organizational or environmental context [C], and how the knowledge is mobilized [facilitation (F)]. This theory states that knowledge will be successfully transferred if it is comprehensible and relevant, if the receivers of the knowledge are open to acceptance, and if the knowledge mobilization is catalyzed effectively (Kitson, et al., 1998; Conklin, et al., 2007). Rehabilitation in home care has received limited research and policy attention. Rehabilitation can make a major contribution to the larger goal of maintaining or improving function and quality of life of home care clients. Gains made in the use and application of health information can benefit home care rehabilitation as well as other home care services. Methods and Results Knowledge Exchange Panels Discussion This study identified barriers and facilitators relevant to all three components to the PARiHS model of knowledge application. In the KE Panels, some factors could be either a barrier or facilitator, depending oŶ iŶdiǀiduals’ paƌtiĐulaƌ edžpeƌieŶĐes. MaŶLJ ďaƌƌieƌs aŶd faĐilitatoƌs ƌelated to ŵethods of faĐilitatiŶg aĐĐess oƌ use of the health information, which gives rise to the potential for innovative techniques to support use of health information. Barriers and facilitators that were identified through the literature review were inconsistent, suggesting a need for additional research in this area, as well as for clearer conceptualizations and definitions. We are continuing to work with home care stakeholders to identify the most significant barriers and facilitators of health information use, and to develop strategies and interventions that could support health information use in home care rehabilitation. References Conklin, J., & Stolee, P. (2008). A Model for Evaluating Knowledge Exchange in a Network Context. Canadian Journal of Nursing Research , 116-124. Egan, M., Wells, J., Byrne, K., Jaglal, S., Stolee, P., Chesworth, B. & Hillier, L. (submitted). Maximizing usefulness of universal assessment data in home care case management: A qualitative study. Health & Social Care in the Community. Kitson, A., Harvey, G., & McCormack, B. (1998). Enabling the implementation of evidence based practice: a conceptual framework. Quality and Safety in Health Care, 7, 149-158. Marshall, M.N., Shekelle, P.G., Leatherman, S., & Brook, R.H. (2000). The public release of performance data. What do we expect to gain? A review of the evidence. Journal of the American Medical Association, 283, 1866-1874. “tolee P, Hillieƌ LM, Weďsteƌ F, O’CallaghaŶ C ;2006Ϳ. “tƌoke Đaƌe iŶ loŶg-term care facilities in Southwestern Ontario. Topics in Stroke Rehabilitation. 13, 97-108. Teare, G.F. & Weiler, L. (2003). Hospital Report 2003: Complex Continuing Care System Integration Change Technical Report. URL: http://www.oha.com/Client/OHA/OHA_LP4W_LND_WebStation.nsf/resources/CCCSICTechReport/$file/2003CCCSICTechReport.pdf Zelmer, J. (2004). From access to quality to outcomes - Using health information to improve health care. CaŶadiaŶ IŶstitute for Health IŶforŵatioŶ Data Users’ CoŶfereŶce, September, Ottawa, ON. Literature Review 838 Articles 144 Articles Retrieved and Reviewed Total Sample = 44 Articles PubMed, CINAHL, & Inspec Databases Search Terms Home Care + EHIS ;e.g. hoŵe Đaƌe seƌǀiĐes, (e.g. MediĐal ReĐoƌds doŵiĐiliaƌLJ Đaƌe, “LJsteŵs, iŶforŵatiĐs, ĐoŵŵuŶitLJ ĐaƌeͿ Đoŵputeƌ-assistedͿ Appeared relevant based on title and abstract (See inclusion and exclusion criteria) + 34 Accepted Articles + 10 Hand- searching Articles - 110 Rejected Articles Inclusion Criteria • The article focuses on electronic health information systems (EHIS) in home care settings • The article includes barriers and facilitators to the use of EHIS in home care Exclusion criteria • The article was published prior to January 1990 - Potentially relevant articles were identified and retrieved based on title of the publication and the content of its abstract - A standardized data inclusion form was used discriminate and document article relevance - The reference lists of the retrieved articles were examined for additional relevant papers - When the relevance was questionable, the two or more authors discussed the paper to arrive at a final conclusion - For each of the selected articles, information was gathered and charted according to the headings: peer reviewed, purpose perspective, methodology, barriers/facilitators, recommendations Toronto Waterloo London Total Participants 14 16 10 Service Providers 2 7 6 Case Managers 8 3 4 Administrators 4 6 Home care administrators, case managers, and rehabilitation providers were recruited through Community Care Access Centres for three sites: Toronto, Waterloo, and London, Ontario. Knowledge exchange brainstorming workshops were conducted in these sites where information was collected via individual and small gƌoup ǁoƌksheets, laƌge gƌoup disĐussioŶs, aŶd a ǁoƌld Đafé ďƌaiŶstoƌŵiŶg teĐhŶiƋue. “takeholdeƌs ǁeƌe asked to identify facilitators and barriers to understanding and using health information systems in homecare settings and plans to ameliorate their use. Barriers Facilitators Team cohesion lacking (C) Fax (F) Interpersonal conflicts (C) Telephone (F) Impersonal communication (C) Voicemail (F) Telephone System (F) Electronic portal (F) Fax (F) Joint visit (F) Cell phone quality (F) Family conference (F) Online availability of forms (F) One-on-one contact (F) Non-integrated tool (F) Reporting tools (E) Slow equipment (F) Team meetings (F) No frontline access (C) Case conferences (F) Centralized access to client file (C) Cell phones (F) Consistency between CCACs (C) Information shared in timely manner (E) Data quality (E) In-service training (C) Collected information not used (E) Agency workshops (C) Acknowledgements We acknowledge the contributions of everyone involved in the KE Panels, and the other members of the InfoRehab research team. This study was funded by the Canadian Institutes of Health Research. Student Contact Information Brandie Steeves Health Sciences and Gerontology University of Waterloo Masters of Public Health Barriers Facilitators Recommendations Cost (technology, training, maintenance) especially during early implementation PCs / portable technology that allow data to be input at point of care Necessary / mandatory training – need to address learning curves / different information needs Training  cost, time commitment, initial loss of productivity Strategies provided by IT to decrease data entry errors Develop a centralized, standardized, comprehensive EHIS Staff resistance / lack of user acceptance Managerial support & user incentives during adoption & early implementation Real time viewing / entering of data / mobility of data Poor data quality standards Compatibility with other IS within the organization Ongoing clinical support once system is up & running Lack of hard evidence of the benefit, difficult to measure Compatible with IT systems outside the organization & in other health care settings Funding to cover costs of training / information system Security / patient confidentiality Standardized terminology Seek input from those who are directly involved IT systems are complex, not user friendly Providing training programs that are high quality, well funded, & available to all users Evaluation & quality assurance plans for IS Not including HC workers (users) in development of IS Using internet based technology Establish an Advisory Group / Steering Committee / User Group to address issues Negative effect on client interactions, not client focused (nurse perception) Users have the ability to analyse data within & across patients Research studies should be conducted to determine benefits & outcomes of the systems Lack of experience with IT in HC IT is user friendly & interpretable Security with respect to data is crucial