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. 2018 Jun 26;13(1):87.
doi: 10.1186/s13012-018-0780-3.

Using information communication technology in models of integrated community-based primary health care: learning from the iCOACH case studies

Carolyn Steele Gray  1   2 , Jan Barnsley  3 , Dominique Gagnon  4 , Louise Belzile  5 , Tim Kenealy  6 , James Shaw  3   7 , Nicolette Sheridan  8 , Paul Wankah Nji  9 , Walter P Wodchis  3   10
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Using information communication technology in models of integrated community-based primary health care: learning from the iCOACH case studies

Carolyn Steele Gray et al. Implement Sci. .

Abstract

Background: Information communication technology (ICT) is a critical enabler of integrated models of community-based primary health care; however, little is known about how existing technologies have been used to support new models of integrated care. To address this gap, we draw on data from an international study of integrated models, exploring how ICT is used to support activities of integrated care and the organizational and environmental barriers and enablers to its adoption.

Methods: We take an embedded comparative multiple-case study approach using data from a study of implementation of nine models of integrated community-based primary health care, the Implementing Integrated Care for Older Adults with Complex Health Needs (iCOACH) study. Six cases from Canada, three each in Ontario and Quebec, and three in New Zealand, were studied. As part of the case studies, interviews were conducted with managers and front-line health care providers from February 2015 to March 2017. A qualitative descriptive approach was used to code data from 137 interviews and generate word tables to guide analysis.

Results: Despite different models and contexts, we found strikingly similar accounts of the types of activities supported through ICT systems in each of the cases. ICT systems were used most frequently to support activities like care coordination by inter-professional teams through information sharing. However, providers were limited in their ability to efficiently share patient data due to data access issues across organizational and professional boundaries and due to system functionality limitations, such as a lack of interoperability.

Conclusions: Even in innovative models of care, managers and providers in our cases mainly use technology to enable traditional ways of working. Technology limitations prevent more innovative uses of technology that could support disruption necessary to improve care delivery. We argue the barriers to more innovative use of technology are linked to three factors: (1) information access barriers, (2) limited functionality of available technology, and (3) organizational and provider inertia.

Keywords: Chronic illnesses; Disruptive innovation; Health information technology; Implementation; Integrated health care systems; Multi-morbidity.

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Conflict of interest statement

Ethics approval and consent to participate

Ethics approval was granted through all relevant ethics boards across the three jurisdictions where data collection was conducted. All participants in the study provided consent to participate in this study.

Overall project approval: University of Toronto Research Ethics Board (RIS-31134).

Ontario cases: University of Toronto Research Ethics Board (RIS-31134), Michael Garron Hospital Research Ethics Board (630-1503-Mis-259), and Joint Bridgepoint-West Park Toronto Central CCAC-Toronto Grace Research Ethics Board.

Quebec cases: Research Ethics Committee of the Charles-Le Moyne Hospital (ref. number CE-HCLM-15-001).

New Zealand cases: University of Auckland Human Participants Ethics Committee (UAHPEC) (Ref. 013071).

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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