Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jan 15;28(1):23-32.
doi: 10.1093/jamia/ocaa207.

An implementation model for managing cloud-based longitudinal care plans for children with medical complexity

Grace Wang  1 , Julia Wignall  1 , Dylan Kinard  1 , Vidhi Singh  1 , Carolyn Foster  2 , Sherri Adams  3   4   5 , Wanda Pratt  6   7 , Arti D Desai  1   8
Affiliations

An implementation model for managing cloud-based longitudinal care plans for children with medical complexity

Grace Wang et al. J Am Med Inform Assoc. .

Abstract

Objective: We aimed to iteratively refine an implementation model for managing cloud-based longitudinal care plans (LCPs) for children with medical complexity (CMC).

Materials and methods: We conducted iterative 1-on-1 design sessions with CMC caregivers (ie, parents/legal guardians) and providers between August 2017 and March 2019. During audio-recorded sessions, we asked participants to walk through role-specific scenarios of how they would create, review, and edit an LCP using a cloud-based prototype, which we concurrently developed. Between sessions, we reviewed audio recordings to identify strategies that would mitigate barriers that participants reported relating to 4 processes for managing LCPs: (1) taking ownership, (2) sharing, (3) reviewing, and (4) editing. Analysis informed iterative implementation model revisions.

Results: We conducted 30 design sessions, with 10 caregivers and 20 providers. Participants emphasized that cloud-based LCPs required a team of owners: the caregiver(s), a caregiver-designated clinician, and a care coordinator. Permission settings would need to include universal accessibility for emergency providers, team-level permission options, and some editing restrictions for caregivers. Notifications to review and edit the LCP should be sent to team members before and after clinic visits and after hospital encounters. Mitigating double documentation barriers would require alignment of data fields between the LCP and electronic health record to maximize interoperability.

Discussion: These findings provide a model for how we may leverage emerging Health Insurance Portability and Accountability Act-compliant cloud computing technologies to support families and providers in comanaging health information for CMC.

Conclusions: Utilizing these management strategies when implementing cloud-based LCPs has the potential to improve team-based care across settings.

Keywords: chronic disease; health information exchange; health information interoperability; hospital medicine; patient care planning; patient portals; pediatrics; transitional care; user-computer interface.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Initial implementation model for management of cloud-based longitudinal care plans (LCPs) for children with medical complexity.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Corrigan JM, Adams K, eds. Priority Areas for National Action: transforming Health Care Quality. Washington, DC: National Academies Press; 2003. - PubMed
    1. Bodenheimer T. Coordinating care–a perilous journey through the health care system. N Engl J Med 2008; 358 (10): 1064–71. - PubMed
    1. Cohen E, Berry JG, Camacho X, Anderson G, Wodchis W, Guttmann A.. Patterns and costs of health care use of children with medical complexity. Pediatrics 2012; 130 (6): e1463–70. - PMC - PubMed
    1. Allshouse C, Comeau M, Rodgers R, Wells N.. Families of children with medical complexity: A view from the front lines. Pediatrics 2018; 141 (Suppl 3): S195–201. - PubMed
    1. Turchi RM, Antonelli RC, Norwood KW, et al.Patient- and family-centered care coordination: a framework for integrating care for children and youth across multiple systems. Pediatrics 2014; 133 (5): e1451–60. - PubMed

Publication types