Sustaining "Meaningful Use" in Low-Resource Practices
Sustaining "Meaningful Use" in Low-Resource Practices
CTA is a set of highly structured qualitative methods used for, among other things, understanding and improving the performance of teams of knowledge workers. It has an extensive track record in a number of fields. We conducted detailed CTAs using the Task Diagram and Team Audit methods to understand the organizational routines of 3 rural FQHCs in Michigan, as well as to understand important contextual factors, culture, and interactional dynamics in the context of implementation of a clinical quality management system (CQMS). The FQHCs were in different regions of the state, and varied widely in size and structure. We provided consultation reports with site-specific clinical workflow and organizational recommendations for facilitating the CQMS implementation and observed the impact of the CTA consultations on the FQHCs' implementation processes.
For the present analysis we reexamined the data, which was coded using an established framework for themes involved in decision making and change management (eg, sense making and learning, problem detection and monitoring). We looked for themes informative about each practice's ability to maintain and meaningfully use health IT. The analysis was done by individual immersion and crystallization, followed by team reconciliation in weekly meetings over 4 weeks.
Since 2010, M-CEITA has been delivering direct, in-office technical assistance to over 4,000 providers across Michigan in the areas of engagement; EHR selection, planning, and implementation; and meaningful use of health IT.
M-CEITA's ONC-funded services are targeted to priority primary care providers working in small practices, community health centers, FQHCs, rural health centers, critical access hospitals, and other care settings primarily serving the underserved across Michigan. Hence, M-CEITA's implementation specialists have developed a detailed understanding of practice work-flows and the many barriers that low-resource practices face in implementing and maintaining health IT.
For Project 2, we conducted 70- to 90-minute semistructured interviews with 6 M-CEITA implementation specialists who provided implementation assistance to and evaluated effectiveness in low-resource practices in rural and urban settings across the state. The implementation specialists were chosen for maximum variation in the geographic areas of the state and the sociodemographic characteristics of the practices with which they worked, and within that selection for the maximum years of experience. The interview guide was developed by the study team based on our experience in Project 1, but before the formal analysis described above was completed on Project 1's data. The implementation specialists were encouraged to voice their insights beyond those solicited in the interview guide.
The team conducted 1 round of individual immersion and crystallization followed by weekly team reconciliation meetings specifically targeted to identify major themes relevant to implementation and maintenance, from the interview data for Project 2. This was done concurrently with the Project 1 analysis described above, and the major themes were reconciled with those from the Project 1 analysis. This resulted in a single set of identified major themes.
Methods
Project 1: CTA Consultations for Health IT Implementation
CTA is a set of highly structured qualitative methods used for, among other things, understanding and improving the performance of teams of knowledge workers. It has an extensive track record in a number of fields. We conducted detailed CTAs using the Task Diagram and Team Audit methods to understand the organizational routines of 3 rural FQHCs in Michigan, as well as to understand important contextual factors, culture, and interactional dynamics in the context of implementation of a clinical quality management system (CQMS). The FQHCs were in different regions of the state, and varied widely in size and structure. We provided consultation reports with site-specific clinical workflow and organizational recommendations for facilitating the CQMS implementation and observed the impact of the CTA consultations on the FQHCs' implementation processes.
For the present analysis we reexamined the data, which was coded using an established framework for themes involved in decision making and change management (eg, sense making and learning, problem detection and monitoring). We looked for themes informative about each practice's ability to maintain and meaningfully use health IT. The analysis was done by individual immersion and crystallization, followed by team reconciliation in weekly meetings over 4 weeks.
Project 2: Analysis of M-CEITA Health IT Implementation Specialists' Experiences
Since 2010, M-CEITA has been delivering direct, in-office technical assistance to over 4,000 providers across Michigan in the areas of engagement; EHR selection, planning, and implementation; and meaningful use of health IT.
M-CEITA's ONC-funded services are targeted to priority primary care providers working in small practices, community health centers, FQHCs, rural health centers, critical access hospitals, and other care settings primarily serving the underserved across Michigan. Hence, M-CEITA's implementation specialists have developed a detailed understanding of practice work-flows and the many barriers that low-resource practices face in implementing and maintaining health IT.
For Project 2, we conducted 70- to 90-minute semistructured interviews with 6 M-CEITA implementation specialists who provided implementation assistance to and evaluated effectiveness in low-resource practices in rural and urban settings across the state. The implementation specialists were chosen for maximum variation in the geographic areas of the state and the sociodemographic characteristics of the practices with which they worked, and within that selection for the maximum years of experience. The interview guide was developed by the study team based on our experience in Project 1, but before the formal analysis described above was completed on Project 1's data. The implementation specialists were encouraged to voice their insights beyond those solicited in the interview guide.
The team conducted 1 round of individual immersion and crystallization followed by weekly team reconciliation meetings specifically targeted to identify major themes relevant to implementation and maintenance, from the interview data for Project 2. This was done concurrently with the Project 1 analysis described above, and the major themes were reconciled with those from the Project 1 analysis. This resulted in a single set of identified major themes.
