Digital consultation in primary healthcare: the effects on access, efficiency and patient safety based on provider experience; a qualitative study

Objective To identify a subset of software issues occurring in daily Swedish healthcare practice and devise a set of local solutions to overcome the challenges. Methods A sample of 46 incident reports was collected from one of Sweden's national incident reporting repositories, ranging from June 2019 to December 2021. The reports were first subjected to an algorithm to identify if they were health information technology-related incidents and were analysed using an existing framework, i.e., the Health Information Technology Classification System, to identify the software-related incidents. The incidents associated with software issues were then subjected to thematic analysis, in which themes were extracted and presented under the category assigned by the existing framework used. Results Of 46 reports, 45 (with one exception) were included using the algorithm. Of 45 incidents, 31 software-related incidents were identified using the classification system. Six types of software issues were identified, including software functionality ( n = 10), interface with other software systems or components ( n = 10), system configuration ( n = 7), interface with devices ( n = 2), record migration ( n = 1) and increased volume of transactions ( n = 1). Each issue was further categorised into different themes; for example, software interface-related problems were grouped into ‘two patients being active in the system simultaneously’ ( n = 6) and ‘transfer of patient information’ ( n = 4). Conclusions The study provided some insights into software issues and relevant consequences. A set of local solutions were devised to overcome the present challenges encountered in Swedish healthcare in their daily clinical practice. Systematic identification and characterisation of such software challenges should be a routine part of clinical practice for all major health information technology implementations.

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Associations of perceived changes in work due to digitalization and the amount of digital work with job strain among physicians: a national representative sample

Virtanen,

Kaihlanen,

Saukkonen

et al. 2023

BMC Med Inform Decis Mak

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Background Physicians’ work is often stressful. The digitalization of healthcare aims to streamline work, but not all physicians have experienced its realization. We examined associations of perceived changes in work due to digitalization and the amount of digital work with job strain among physicians. The moderating role of the length of work experience was investigated for these associations. Methods We used representative survey data on Finnish physicians’ (N = 4271) experiences of digitalization from 2021. The independent variables included perceptions on statements about work transformations aligned with digitalization goals, and the extent that information systems and teleconsultations were utilized. Stress related to information systems (SRIS), time pressure, and psychological stress were the dependent variables. We analyzed the associations using multivariable linear and logistic regressions. Results Respondents had a mean SRIS score of 3.5 and a mean time pressure score of 3.7 on a scale of 1–5. Psychological stress was experienced by 60%. Perceptions associated with higher SRIS comprised disagreements with statements asserting that digitalization accelerates clinical encounters (b = .23 [95% CI: .16–.30]), facilitates access to patient information (b = .15 [.07–.23]), and supports decision-making (b = .11 [.05–.18]). Disagreement with accelerated clinical encounters (b = .12 [.04–.20]), and agreements with patients’ more active role in care (b = .11 [.04–.19]) and interprofessional collaboration (b = .10 [.02–.18]) were opinions associated with greater time pressure. Disagreeing with supported decision-making (OR = 1.26 [1.06–1.48]) and agreeing with patients’ active role (OR = 1.19 [1.02–1.40]) were associated with greater psychological stress. However, perceiving improvements in the pace of clinical encounters and access to patient information appeared to alleviate job strain. Additionally, extensive digital work was consistently linked to higher strain. Those respondents who held teleconsultations frequently and had less than 6 years of work experience reported the greatest levels of time pressure. Conclusions Physicians seem to be strained by frequent teleconsultations and work that does not meet the goals of digitalization. Improving physicians’ satisfaction with digitalization through training specific to the stage of career and system development can be crucial for their well-being. Schedules for digital tasks should be planned and allocated to prevent strain related to achieving the digitalization goals.

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Digital consultation in primary healthcare: the effects on access, efficiency and patient safety based on provider experience; a qualitative study

Cited by 5 publications

References 22 publications

Systematic Literature Review: Factors Affecting Satisfaction in Using Telehealth Services

Systematic Literature Review: Factors Affecting Satisfaction in Using Telehealth Services

Software-related challenges in Swedish healthcare through the lens of incident reports: A desktop study

Associations of perceived changes in work due to digitalization and the amount of digital work with job strain among physicians: a national representative sample

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