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Task analysis of information technology-mediated medication management in outpatient care

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Author: Stiphout, F. van · Zwart-van Rijkom, J.E.F. · Maggio, L.A. · Aarts, J.E.C.M. · Bates, D.W. · Gelder, T. van · Jansen, P.A.F. · Schraagen, J.M.C. · Egberts, A.C.G. · Braak, E.W.M.T. ter
Type:article
Date:2015
Publisher: Blackwell Publishing Ltd
Source:British Journal of Clinical Pharmacology, 3, 80, 415-424
Identifier: 528007
doi: doi:10.1111/bcp.12625
Keywords: Pharmacology · Education · Human factors · IT · Medication management · Task analysis · Cognition · Conceptual framework · Decomposition · Formal task analysis · Information technology · Integration · Interpersonal communication · Interview · Job performance · Macrocognitive task · Managed care · Medical education · Medication therapy management · Outpatient care · Patient safety · Physician attitude · Responsibility · Task performance · Treatment planning · Workflow · Human & Operational Modelling · HOI - Human Behaviour & Organisational Innovations · ELSS - Earth, Life and Social Sciences

Abstract

Aims Educating physicians in the procedural as well as cognitive skills of information technology (IT)-mediated medication management could be one of the missing links for the improvement of patient safety. We aimed to compose a framework of tasks that need to be addressed to optimize medication management in outpatient care. Methods Formal task analysis: decomposition of a complex task into a set of subtasks. First, we obtained a general description of the medication management process from exploratory interviews. Secondly, we interviewed experts in-depth to further define tasks and subtasks. Setting: Outpatient care in different fields of medicine in six teaching and academic medical centres in the Netherlands and the United States. Participants: 20 experts. Tasks were divided up into procedural, cognitive and macrocognitive tasks and categorized into the three components of dynamic decision making. Results The medication management process consists of three components: (i) reviewing the medication situation; (ii) composing a treatment plan; and (iii) accomplishing and communicating a treatment and surveillance plan. Subtasks include multiple cognitive tasks such as composing a list of current medications and evaluating the reliability of sources, and procedural tasks such as documenting current medication. The identified macrocognitive tasks were: planning, integration of IT in workflow, managing uncertainties and responsibilities, and problem detection. Conclusions All identified procedural, cognitive and macrocognitive skills should be included when designing education for IT-mediated medication management. The resulting framework supports the design of educational interventions to improve IT-mediated medication management in outpatient care. © 2015 The Authors. British Journal of Clinical Pharmacology published by John Wiley and Sons Ltd on behalf of The British Pharmacological Society.