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. 2019 Jul 15;21(7):e13143.
doi: 10.2196/13143.

Implementation of a Digitally Enabled Care Pathway (Part 2): Qualitative Analysis of Experiences of Health Care Professionals

Alistair Connell  1   2 , Georgia Black  3 , Hugh Montgomery  1 , Peter Martin  3 , Claire Nightingale  3   4 , Dominic King  2 , Alan Karthikesalingam  2 , Cían Hughes  2 , Trevor Back  2 , Kareem Ayoub  2 , Mustafa Suleyman  2 , Gareth Jones  5 , Jennifer Cross  5 , Sarah Stanley  5 , Mary Emerson  5 , Charles Merrick  5 , Geraint Rees  6 , Christopher Laing  5 , Rosalind Raine  3
Affiliations

Implementation of a Digitally Enabled Care Pathway (Part 2): Qualitative Analysis of Experiences of Health Care Professionals

Alistair Connell et al. J Med Internet Res. .

Abstract

Background: One reason for the introduction of digital technologies into health care has been to try to improve safety and patient outcomes by providing real-time access to patient data and enhancing communication among health care professionals. However, the adoption of such technologies into clinical pathways has been less examined, and the impacts on users and the broader health system are poorly understood. We sought to address this by studying the impacts of introducing a digitally enabled care pathway for patients with acute kidney injury (AKI) at a tertiary referral hospital in the United Kingdom. A dedicated clinical response team-comprising existing nephrology and patient-at-risk and resuscitation teams-received AKI alerts in real time via Streams, a mobile app. Here, we present a qualitative evaluation of the experiences of users and other health care professionals whose work was affected by the implementation of the care pathway.

Objective: The aim of this study was to qualitatively evaluate the impact of mobile results viewing and automated alerting as part of a digitally enabled care pathway on the working practices of users and their interprofessional relationships.

Methods: A total of 19 semistructured interviews were conducted with members of the AKI response team and clinicians with whom they interacted across the hospital. Interviews were analyzed using inductive and deductive thematic analysis.

Results: The digitally enabled care pathway improved access to patient information and expedited early specialist care. Opportunities were identified for more constructive planning of end-of-life care due to the earlier detection and alerting of deterioration. However, the shift toward early detection also highlighted resource constraints and some clinical uncertainty about the value of intervening at this stage. The real-time availability of information altered communication flows within and between clinical teams and across professional groups.

Conclusions: Digital technologies allow early detection of adverse events and of patients at risk of deterioration, with the potential to improve outcomes. They may also increase the efficiency of health care professionals' working practices. However, when planning and implementing digital information innovations in health care, the following factors should also be considered: the provision of clinical training to effectively manage early detection, resources to cope with additional workload, support to manage perceived information overload, and the optimization of algorithms to minimize unnecessary alerts.

Keywords: acute kidney injury; nephrology.

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Conflict of interest statement

Conflicts of Interest: CL, HM, GR, and RR are paid clinical advisors to DeepMind. AC’s clinical research fellowship was part-funded by DeepMind. CL was a member of the National Institute for Health and Care Excellence clinical guideline 169 development group referenced in the paper. DeepMind remained independent from the collection and analysis of all data. HM coholds a patent on a fluid delivery device that might ultimately help in preventing some (dehydration-related) cases of AKI occurring. DeepMind was acquired by Google in 2014 and is now a part of the Alphabet group. The deployment of Streams at RFH was the subject of an investigation by the Information Commissioner’s Office in 2017. RFH has since published an audit completed to comply with undertakings following this investigation [43]. In November 2018, it was announced that the Streams team will be joining Google as part of a wider health effort [44].

Figures

Figure 1
Figure 1
Pre- and postintervention care pathways. AKI: acute kidney injury.
See this image and copyright information in PMC

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