Incorporating patient-generated contextual data into care: Clinician perspectives using the Consolidated Framework for Implementation Science.

Abstract

Patient contextual data (PCD), defined as patient's values, environment, or behavior influencing health, are essential to the proper care of patients, yet often are missing in the electronic health record (EHR). The current EHR structures and practice demands produce barriers to document PCD systemically. We sought to understand clinicians' perceived facilitators and barriers to use PCD using a consumer informatics technology integrated into the EHR. The PCD components include patient perceived pressures; joys; preferred approach to care; perceived health; health-goals; and visit agenda. We conducted semi-structured interviews of twenty primary care clinicians from an academic health system implementing a PCD initiative. The analysis included an inductive approach and a deductive a priori framework, the Consolidated Framework for Implementation Research (CFIR). Clinicians identified the following facilitators of adoption: reinforcement of patient engagement; a focus on enhancing team-based care; and communication around how the tool can be incorporated for individualized care. Clinicians identified barriers as: challenges incorporating PCD into the time-compressed visit and reviewing the tool involved another click in the EHR. The deductive results spanned four domains and seven constructs of CFIR, principally finding intervention source, relative advantage, organizational needs, and relative priority as facilitators with a need for ongoing leadership for the culture change. Overall, clinicians supported the adoption of a consumer informatics technology, as they reflected on the perceived value of a new data source to enhance patient-centered care and involvement in the development process. User-focused optimization efforts aided in the improved functionality and adoption of the application.