JMIR Publications

ABSTRACT

Background:

The hospitalist workday is cognitively demanding and dominated by activities away from patients’ bedside. While mobile technologies are offered as solutions, clinicians report lower expectations of mobile technology after actual use.

Objective:

The purpose of this study was to better understand opportunities for integrating mobile technology and applications (“apps”) into hospitalists’ workflows. We aimed to identify difficult tasks and contextual factors that introduce inefficiencies and characterize hospitalists’ perspectives on mobile technology and apps.

Methods:

We conducted a workflow analysis based on semi-structured interviews. At a Midwestern US medical center, we recruited physicians and nurse practitioners from hospitalist and inpatient teaching teams and internal medicine residents. Interviews focused on tasks perceived as frequent, redundant, and difficult. Also, participants were asked to describe opportunities for mobile technology interventions. We analyzed contributing factors, impacted workflows, and mobile app ideas.

Results:

Over three months, we interviewed twelve hospitalists. Participants collectively identified chart reviews, orders, and documentation as the most frequent, redundant, and difficult tasks. Based on those tasks, the intake, discharge, and rounding workflows were characterized as difficult and inefficient. Difficulty was associated with a lack of access to EHRs at bedside. Contributing factors for inefficiencies were poor usability and inconsistent availability of health information technology combined with organizational policies. Participants thought mobile apps designed to improve team communications would be most beneficial. Based on our analysis, mobile apps focused on data entry and presentation supporting specific tasks should also be prioritized.

Conclusions:

Based on our results, there are prioritized opportunities for mobile technology to decrease difficulty and increase efficiency of hospitalists’ workflows. Mobile technology and task-specific mobile apps with enhanced usability could decrease over-reliance on hospitalists’ memory and fragmentation of clinical tasks across locations. This study informs design and implementation processes of future health information technologies to improve continuity in hospital-based medicine.