International Conference on Naturalistic Decision Making 2013, Marseille, France Authors retain copyright of their work H. Chaudet, L. Pellegrin & N. Bonnardel (Eds.). Proceedings of the 11th International Conference on Naturalistic Decision Making (NDM 2013), Marseille, France, 21‐24 May 2013. Paris, France: Arpege Science Publishing. ISBN 979‐10‐92329‐00‐1 Health IT-related obstacles and facilitators in coordinating care for patients with chronic illness: A longitudinal study Pascale CARAYON a,b , Sarah KIANFAR a,b , Ann SCHOOFS HUNDT a , Janet TOMCAVAGE c , Doreen SALEK c , Janet PETRUCCI c , Peter HOONAKKER a , Bashar ALYOUSEF a,b , & James WALKER c a Center for Quality and Productivity Improvement, University of Wisconsin-Madison b Department of Industrial and Systems Engineering, University of Wisconsin-Madison c Geisinger Health System ABSTRACT Introduction: Coordinating care for patients with chronic illness is a major challenge for healthcare as these patients interact with multiple providers and healthcare organizations during their journey. Health information technology (IT) has been proposed to support care coordination, but can bring its own challenges. In this longitudinal study we examined the obstacles and facilitators experienced by care managers in using various forms of health IT. Methods: We interviewed 14 hospital and outpatient care managers who coordinated care for patients with chronic illnesses across multiple transitions of care. These interviews were conducted over a period of one year. Results and discussion: Care managers experienced both obstacles and facilitators in their use of health IT for care coordination. Despite technical and human factors problems with the technologies, care managers described several benefits of health IT. KEYWORDS Care coordination; health information technology; performance obstacles and facilitators; longitudinal study. INTRODUCTION Care of patients with chronic illness accounts for approximately three quarters of all healthcare expenditures in the US (Bodenheimer, 2002). It has been difficult to design and implement sustainable interventions to coordinate care for these patients as they transition among hospitals, home, clinics, and nursing homes. Health information technology (IT) can play a key role in supporting care coordination; however, the use of health IT to improve care for patients with chronic illness can be challenging (Alyousef et al., 2012; Bates, 2010; Carayon et al., 2012). In this study we focus on the role of care managers who coordinate care for patients with chronic illness and identify the obstacles and facilitators that they experience in using various forms of health IT to access, share and manage patient information. BACKGROUND Care coordination for patients with chronic illnesses such as heart failure (HF) or chronic obstructive pulmonary disease (COPD) can be very complex. These patients often journey through multiple transitions of care as they are cared by numerous providers and healthcare organizations. These transitions pose unique coordination challenges because of the large variety of healthcare professionals and organizations involved in patient care. Numerous studies have identified care quality and patient safety issues in these care transitions (Holland & Harris, 2007; Kahn & Angus, 2011; Nelson & Carrington, 2011). Health IT has been suggested as a key component of care coordination; but numerous challenges have been identified in the use of health IT for care coordination for patients with chronic illness (Bates, 2010; Carayon et al., 2012; O'Malley, 2011). Challenges include communication and sharing of information among clinicians and healthcare organizations, and information overload (Bates, 2010). O’Malley et al. (2010) interviewed 60 physicians and staff in 26 physician practices about their experience with electronic health records (EHR), i.e. one type of health IT, and the use of EHR to support coordination activities. Both EHR-related facilitators and obstacles to care coordination were identified. For instance, the EHR can provide immediate access to patient information (facilitator), but it may be hard to find information in the EHR (obstacle). Further understanding of care coordination challenges and opportunities for improvement offered by health IT is necessary. Many different models have been proposed to improve care coordination. Recently, the patient-centered medical home (PCMH) has been developed as a new way of organizing primary care to benefit all patients, but more