international journal of medical informatics 79 ( 2 0 1 0 ) 112–122 journal homepage: www.intl.elsevierhealth.com/journals/ijmi Challenges to inter-departmental coordination of patient transfers: A workflow perspective Joanna Abraham, Madhu C. Reddy * College of Information Sciences and Technology, The Pennsylvania State University, United States article info Article history: Received 3 May 2009 Received in revised form 4 November 2009 Accepted 9 November 2009 Keywords: Cooperative behavior Inter-departmental workflows Patient transfers Coordination Information management Clinical and non-clinical departments Qualitative study abstract Objective: The purpose of this study is to identify challenges to inter-departmental coor- dination activities that affect patient transfer workflow and to provide socio-technical requirements for the design of technologies to better support patient transfer workflow. Design: We conducted our study in two clinical and one non-clinical department at a major academic hospital. We utilized qualitative data collection techniques including observations of patient transfer practices of the different departments and interviews with departmental staff to collect data on the inter-departmental coordination activities and its effect on patient transfer workflow. Results: We identified three inter-departmental challenges that affected the patient transfer workflow: ineffective inter-departmental interactions, ineffective information handoffs, and ineffectiveness of current information technologies. Discussion: To address these challenges, we discuss three socio-technical design require- ments that designers need to pay attention to while developing inter-departmental healthcare information systems. To ensure effective inter-departmental coordination, the systems should incorporate features that can support the mediating role of integrators, the collaborative balancing of goals, and the collaborative prioritization of resources. © 2009 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Patient transfers are an important aspect of hospital work- flow; on average 40–70% of patients in inpatient departments of U.S. hospitals are transferred each day [1]. Consequently the patient transfer process impacts both organizational and clin- ical goals of the hospital. Currently, many hospitals function at 100% patient capacity. Therefore, on one hand, ensuring that patients are transferred efficiently and quickly is crucial to achieve effective patient flow within the hospital [2]. On the other hand, the patient transfer process impacts whether appropriate care is delivered in a timely and effective manner. For instance, patients with complex care requirements need ∗ Corresponding author at: 321J IST Building, College of Information Sciences and Technology, The Pennsylvania State University, University Park, PA 16802-6823, United States. Tel.: +1 814 863 6316; fax: +1 814 865 6426. E-mail addresses: jabraham@ist.psu.edu (J. Abraham), mreddy@ist.psu.edu (M.C. Reddy). to be moved between clinical departments that can provide the services and care appropriate for those patients. Furthermore, since patient transfers involve multiple departments the patient transfer workflow impacts not only activities within a single department but also activi- ties that take place between multiple departments. Hence, one of the key features for maintaining effective patient transfer workflow is developing seamless inter-departmental coordination technologies. However, current healthcare tech- nologies employed in most hospitals (e.g. electronic medical record and computerized patient order entry systems) are designed to be used primarily by clinical departmental staff and therefore, mainly are focused on patient care activities such as physician order entry, medication administration, 1386-5056/$ – see front matter © 2009 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijmedinf.2009.11.001