INTERDISCIPLINARY COLLABORATION: A HEALTH INFORMATION TECHNOLOGY APPROACH FOR HEALTH CARE PROFESSIONALS
Interdisciplinary collaboration can be improved by using Health Information Technology (HIT) to assist the patients better. The key motivations for using a smartphone in healthcare settings to enhance interdisciplinary collaboration has been the need for information resources and better communication at the point of care. The importance of smartphone and apps for healthcare professionals in interdisciplinary collaboration include; convenience, better clinical decisions, improved accuracy, increased efficiency and enhanced productivity.
In today’s workplace, many activities involve working in a group or team 1. Virtually all economic and societal sectors are increasingly emphasizing on teamwork. This reflects the growing evidence that when people with differing training, knowledge, attitudes and experience find new of working in a team, the result is increased synergy, productivity, and innovation. The need for defining teamwork and encouraging its application in healthcare is not new. However, Talley & Travis2 indicated that the series of primary healthcare field developments have demonstrated how significant it is to coordinate working practice. These include; (1) unprecedented flow of technical and scientific information that show the important roles different healthcare providers play; (2) High levels of knowledge and awareness among clients/patients with a concomitant demand for better and more services; (3) a growing focus on the population and prevention health; (4) shift to the client-centred approach; (5)patients with some complex needs being treated at the community, basically because of early discharge from the hospital; and (6) the need for 24/7 healthcare for timely access to health care providers for the citizens, no matter where they reside.
Interdisciplinary refers to a deeper collaboration degree among the team members. It implies expertise and knowledge integration of many disciplines to come up with solutions to complex problems in an open-minded ad flexible way4. This type of team is characterized by common goals ownership and shared process of decision-making. According to Freshman, Rubino & Chassiakos, 3interdisciplinary teams members must open territorial boundaries to give more flexibility in their professional responsibilities for them to meet the needs of the clients.
Collaboration according to Freshman, Rubino & Chassiakos, 3is a dynamic process focusing on sharing, partnership, interdependence, and power. Sharing includes shared values, healthcare philosophy, responsibilities, planning, and interventions. Partnership implies that more people come together in a productive, authentic and collegial relationship, characterized by honest and open communication, respect and mutual trust. Every partner must value the perspective and work of the other professionals and strive towards specific outcomes and common goals. Interdependence implies that the professionals are not autonomous but interdependent, because of their common desire for fulfilling the needs of the patients/clients. Lastly, power is shared among the members of the team, with all participants accorded empowerment. It should be based on experience and knowledge, rather than on titles or functions.4
Petri4 described the collaborative practice as centred on the patient and refers to it as a “new professional practice direction where the professionals of healthcare work together with the patients.” collaborative practice involves continuous interaction with many disciplines or professionals into a common effort to solving or exploring common issues, with the patient’s best possible participation. It is designed to promote each discipline of active participation in inpatient care. Moreover, collaborative practice enhances family and patient-centred goals and values, optimizes participation of staff in clinical decision making across and within disciplines, provides mechanisms to caregivers for continuous communication, and fosters respect for all professionals for disciplinary contributions.5
Health information technology
The concept of Health Information Technology (HIT) is based on the definition of the world health organization of health. The information technology on health indicates that digital technology facilitates the achievement of accessible, equal and high-quality healthcare for all members of society. WHO6 defined HIT as the uses of digital technology to treat patients, educate students, conduct research, monitor public health and track diseases among others.
The healthcare service according to Lyhne7 is strongly dependent on information and knowledge. Digital technology in the form of information and technology, constitutes an integrated and vital part of healthcare. Black et al8 stated that the use of digital technology will increase in the future in interdisciplinary collaboration, communication and patient care between different organizations and stakeholders such as in quality improvement, coordination, administration, and research. Information communication and technology is mainly employed to; facilitate the handling, transfer and storage of data; to facilitate health care from a distance, and to support clinical decisions.9
The health care professionals are required to be updated and prepared in facing and taking part in the development of HIT based on a professional perspective. Information technology services development in society, such as social media, impacts the healthcare already. WHO9 pointed out that in 2010, the uses of wireless telecommunication were over five billion with a coverage of 85% of the global population. Patient’s access to information increases their opportunities of assuming responsibility for their health. For instance, patients suffering from high blood pressure and diabetes who performs self-tests combining with feedback and health information via Telemedical devices. Such developments make the healthcare professionals assume a guiding and supportive role about a more informed and knowledgeable patient.11
In the efforts of the healthcare professionals to provide person-centred care to the patients, they are faced with new demands and needs. The development of HIT implies patients benefit such as a possibility of influencing future and present health and social care provision, increased flexibility.
According to Lyhne, 7 HIT can support processes of healthcare to ensure patient safety, quality, continuity and person-centred approach in the process of care. The healthcare professionals have the function of coordinating in the organization that includes handling of the information that is related to health. This information should always be available to the right person, on the right occasion and in the right format in the process of care for the provision, decision-making, and healthcare evaluation. A prerequisite for HIT to develop in that direction and to meet care needs of the patients is that the health care professionals, contribute to their commitment and knowledge, irrespective of their roles through interdisciplinary collaboration.
Communication and interdisciplinary collaboration
HIT influences the patient-nurse encounter. Even though it can add value to the processes of care delivery based on the needs of the patients, there is also the risk of HIT causing alienation and frustration. Nilsson & Söderberg 12 asserted that in the encounter involving two individuals, the technology should not be dominating but rather supportive. A key objective of such kind of interaction is to support the involvement, continuity and integrity of the patients and the significant others by considering their perspectives. Involvement and continuity can be strengthened by digital technology means, but health care professionals must take care and ensure that the integrity of the patients perseveres. Digital technology communication differs depending on the technical and form of solution employed. For instance. For instance, communication in real-time during home care video conference allows dialogue and two-way communication, while SMS, email, written texts or discussion forums in electronic patient records can instead be described as one-way communication methods. However, home video conference allows for greater flexibility in terms of space and time.
CeHis13 gave an example of an e-Health service in Sweden created by Center for e-Health in Sweden called “The National Patient Summary (NPO).” This service allows healthcare professionals, with the consent of the patients, to access the record information of the patients registered by other health care providers. Similarly, within European Union, epSOS, an ongoing development project aims to create possibilities for exchanging record information of the patient between the member states of EU.14 Additionally, other HIT services such as “1177.se Healthcare Online” and “My Healthcare Contacts” are directed to the patients and the significant others to facilitate handling of prescriptions, bookings appointments, counselling among others. Moreover, “My Healthcare Services” will allow the patients to access and also enter information in their personal medical records.
According to Nilsson et al, 12 distance care to patients provided via Telenursing and telemedicine enables more efficient use of resources and specialists competence. Additionally, it can facilitate independent living and increase the sense of safety for the patients, as it becomes easier having contact with the allocated nurse on duty, hence enhancing accessibility.
HIT services can facilitate communication of the nurses with the patients and significant others. However, it is important to minimize threats and risks to dignity, integrity and confidentiality by respecting individual preferences and preconditions of the patient for communication. Wakefield10 indicated that the power balance between the healthcare professional and nurse shifts when the patient has access to information online about ill health and health. Furthermore, it places greater demand on the healthcare professionals to act as guides and advisors about the individual efforts of the patients in attaining and maintaining health. The online information that is not objective and is misleading can cause worry or confusion among the patients and the significant others. The educational function of the healthcare professional becomes more important and comes along with the need for developing evidence-based educational material to apply in ICT solutions for the patients. Lymberis11 asserted that such material can be used in a face-to-face meeting between the health care professional and patient or via the internet, according to the needs of the patient and situation.
Smartphone usage in healthcare settings to enhance interdisciplinary collaboration
The smartphone is becoming an important device that assists physicians with clinical tasks, medical decision-making, and other computing functions. A smartphone according to PC Magazine Encyclopedia 15 is a device combining mobile communication, accessibility of internet and word processing. In this section of this practice-focused research paper, it examines the software applications related to health care that is available across most smartphone platforms. PC Magazine Encyclopedia15 indicated that software applications of smartphones are increasingly becoming popular for both healthcare providers and consumers. Furthermore, the paper will discuss the importance of using smartphones as a HIT to improve interdisciplinary collaboration among healthcare professionals.
The use of smartphones by the health care professionals according to Wallace, Clark and White16 has transformed many clinical practice aspects. Smartphones have become common in healthcare settings, and this has led to the rapid developmental growth of medical software applications for these platforms. 16, 17 Aungst 17 pointed out that numerous applications are available to help the health care professionals with many important tasks such as health record access and maintenance, time and information management, consulting and communication, patient monitoring and management, reference and information gathering, medical training and education, and clinical decision-making. 16-26
Smartphones combine both communications and computing features in a single mobile device that can be stored in a pocket and held in hand, permitting easy access and to be used at the point of care.18 Additionally, apart from text and voice, smartphones offer more advanced features such as global positioning service (GPS), web searching, sound recorders, and high-quality cameras.19 With all these features combined with operating systems, powerful processor, high-resolution screens, large memories, smartphones have become handheld computers.19
Need for smartphones at the point of care for interdisciplinary collaboration
One of the key motivations that drive the widespread adoption of smartphones by healthcare providers has been the need for information resources and better communication for interdisciplinary collaboration at the point of care. 18, 20 Ideally, healthcare professionals require access to different types of resources in a healthcare setting, which includes:
- Communication capabilities with the team embers such as email, text, video conferencing and voice 18
- Hospital information systems which include electrical medical records, electronic health records, picture archiving and communication systems, clinical decision support systems, andlaboratoryinformation18
- Informational resources such as drug references, medical literature, guidelines and 18
- Clinical software applications such as medical calculators, and diseases diagnosis 18
Before the development of mobile devices such as the smartphones these resources were mainly available and provide by immobile computers, which hindered mobility in the healthcare settings.18 However, with the availability of mobile devices such as smartphones, the health care professionals now have the access to large information sources at their fingertips
In a study conducted by Manhattan Research in 2012, the results identified the purpose for which the health care professionals rely on mobile devices such as smartphones.21 The most popular activity was searching among health care professionals with 56% using smartphones.21 Among the physicians using smartphones alone, searching was also the most common activity taking 48% of their phone time. Additionally, professional applications in the smartphones consumed an additional of 38%.moreover, physicians averagely spent three hours weekly watching online videos for professional purposes on smartphones by 13%, tablets 29% and laptops or desktop computers 67%.21
Smartphone Apps for healthcare professionals
The rapid integration of smartphones into clinical practice has been driven in part by rising quality and availability of medical software applications also referred to as “Apps”20. Apps according to Wallace, Clark, White, 16 are software programs developed to run on mobile devices or computers to accomplish a specific purpose. Improved memory, faster processors, open-source operating systems that are highly efficient and perform complex functions, and smaller batteries have paved the way for the development of many medical apps for mobile devices for both personal and professional use. 22
How healthcare professionals use smartphones and Apps to enhance interdisciplinary collaboration
Health care professionals our smartphones and apps for interdisciplinary collaboration purposes which can are grouped into five broad categories: health record access and maintenance, administrations, reference and information gathering, communication and gathering, and medical education. Table 2 below shows the many uses for a smartphone, and Table 2 shows types of medicals apps falling under the broad category purposes as illustrated by Ventola .23
Table 1: Uses for smartphone and apps by healthcare professional
|Information management||v Dictate notes
v Write notes
v Record audio
v Organize information and images
v Take photographs
v Access cloud service
v Use e-book reader
|Time management||v Record call schedule
v Schedule meetings
v Schedule appointments
|Health record access and maintenance||v Access images and scans
v Access EMRs and EHRs
v Electronic prescribing
v Coding and billing
|Communication and consulting||v Video calling
v Voice calling
v Video conferencing
v Multimedia messaging
v Social networking
|Reference and information gathering||v Medical journals
v Medical textbooks
v Literature search portals
v Medical literature
v Medial news
v Drug reference guides
|Clinical decisions making||v Clinical treatment guidelines
v Clinical decision support systems
v Differential diagnosis aids
v Disease diagnosis aids
v Laboratory test ordering
v Medical calculators
v Medical exams
v Laboratory test interpretations
|Patient monitoring||v Monitor location of the patient
v Monitor patient health
v Collect clinical data
v Monitor patient rehabilitation
v Monitor heart function
|Medical training and education||v Knowledge assessment tests
v Continuing medical education
v Case studies
v Board exam preparation
v Surgical simulations
v E-learning and teaching
v Skill assessment tests
Table 2: Uses of Medical Apps by healthcare professionals
|Information management||ü Notability
ü Google Drive
|ü Note taking and organization
ü Note taking and organization
ü PDF Viewer
ü PDF viewer
ü file sharing and cloud storage
ü file sharing and cloud storage
ü file sharing and cloud storage
|Communication and consulting||ü Doximity||ü Social networking site for the MDs|
|Reference and information gathering||ü Dynamed
ü John Hopkins Antibiotic Guide
ü Medpage Today
ü Sanford Guide to Antimicrobial Therapy
|ü Drug and medical reference
ü Drug and medical reference
ü Drug reference
ü Drug and medical reference
ü Medical reference
ü Medical reference
ü Medical reference
ü Medical reference
ü Medical news
ü Medical reference
|Patient management and monitoring||ü Pocket lab values
ü Lab Pro Values
ü AHRQ ePSS
|ü Laboratory reference
ü Differential diagnosis
ü Medical calculator
ü Laboratory reference
ü Medical calculator
ü Medical calculator
ü Screening and prevention tool
ü Medical calculator
|Medical training and education||ü QuantiaMD
ü MedPage Today
|ü Continuing medical education
ü Continuing medical education
Importance of smartphone and apps for healthcare professionals in interdisciplinary collaboration
Clinicians collaborating in a team associate numerous conveniences with using smartphone in their clinical practice such as rapid access to multimedia resources and information, portability, choice of different powerful apps to complete many purposes 16, 19. Healthcare professionals in a team can access information simultaneously with many conveniences, keeping current by accessing updates about new reviews, guidelines, new books and medical literature conveniently
Better clinical decision-making
Several medical apps in smartphone support clinical decision making by clinicians in a team at the care point. 18, 25 This is essential in evidence-based medicine since healthcare professionals nay not seek answers always to the clinical questions after completing their clinical encounter. 20, 18, 25 The most useful smartphone tools that support clinical decision-making and evidence-based medicine as cited by practising clinicians practising interdisciplinary collaboration include medical textbook, drug reference, medical calculator apps and diseases diagnosis.18
According to Divali, 19 mobile devices including smartphones have repeatedly been found to improve the accuracy and completeness of patient documentation, and this has been attributed to their ease of use. Moreover, increased medication safety, more frequent side effects documentation and more accurate diagnostic coding through reduced medical errors among the clinicians have been reported.25 Furthermore, timely communication amongst clinicians collaborating as a team within a hospital has also been found to reduce medical errors, particularly in critical care
Kiser 22 indicated that interdisciplinary collaborating healthcare workers using smart phones are efficient in their work areas. Other increased efficiency to interdisciplinary collaborating healthcare workers through the use of smartphones include rapid access to information, increased patient documentation quality through complete records and fewer errors, and improved patterns of the workflow.25 Use of smartphones to retrieve information from the drug database has efficiently made decision-making and care for the patients easy to the physicians. Moreover, Mickan 26 asserted that physicians also reported more efficient and quicker access to the clinical support resources and improved care coordination by the collaborating physicians
Aungst 17 demonstrated that use of smartphones inpatient care has helped in streamlining workflow and increasing productivity of the healthcare professionals. Moreover, it causes a significant increase in the electronic prescribing average rate to 64% from 53%. 26 Productivity of the pharmacists can also be increased by allowing important information on drugs, such as interactions and contraindications, to be quickly checked, hence more rapid prescription processing.26
Interdisciplinary collaboration approach is gradually being used more in primary HealthCare. Patients or clients must also be involved in interdisciplinary collaboration for them to be included in their own care. The health system also needs to have channels by which the patients and their families can get involved in the planning, assessment and delivery of healthcare.
HIT should provide person-centred and equal care. Moreover, HIT is an important tool for increasing patient involvement and accessibility in healthcare. Therefore, it should form part of all the levels of professional practice and medical education.
Mobile medical devices especially smartphones and apps are already invaluable medical tools for the healthcare professionals, and as their uses and features expand, they are becoming widely incorporated into almost every aspect of the clinical practice and in interdisciplinary collaboration. Despite the fact smartphones, apps, and other mobile medical devices provide the physicians with many advantages, they are being used currently without an in-depth understanding of their associated benefits and risks.
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- Nilsson C, L & Söderberg S. Swedish District nurses’ experiences on the use of information and communication technology for supporting people with serious chronic illness living at home – a case study. Scandinavian Journal of Caring Science. 2010: 24:259–265.
- National patientöversikt (NPÖ) (The National Patient Summary).2012. http:// www.cehis.se/vardtjanster/npo. Accessed February 1, 2015
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- PC Magazine Encyclopedia. Mobile app [search term]. PC Magazine, The Computer Language Company Inc, 2011. http://www.pcmag.com/encyclopedia_term/0%2C1237%2Ct%3Dmobile+app&i%3D60015%2C00.asp. Accessed February 1, 2015.
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- Kiser K. 25 ways to use your smartphone. Physicians share their favourite uses and apps. Minn Med. 2011;94(4):22–29.
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- Mickan S, Tilson JK, Atherton H, et al. Evidence of effectiveness of health care professionals using handheld computers; a scoping review of systematic reviews. J Med Internet Res. 2013;15(10):e212.