Using Activity Theory and Task Structure Charts to Model Patient-Introduced Online Health Information into the Family Physician/Patient Examination Process

Abstract

This research study was undertaken to gain a richer understanding of the use of patient-introduced online health information during the physician/patient examination and communication process. Utilizing qualitative data obtained from ten family physician interviews and workflow modeling of the data using activity diagrams and task structure charts, this study uncovered the frequency of patient-introduced online health information, physician suggested online resources, use of email for physician/patient communication, use of electronic medical records, along with tasks involved and methods used by the physicians to work the online health information into the physician/patient examination and knowledge transfer process.

Appendix A: Physician Interview Questions

Thank you for participating in this interview today. This interview should take approximately 30 min to complete. I would like to assure you that all of your responses will remain confidential. You will be assigned a participant code that will be used to maintain your anonymity. Your participant code for this study is FP###.

(Hand the participant the confidentiality agreement to read and sign with their participant code already entered on the form.)

By signing the confidentiality agreement you have agreed that your responses may be recorded on audiotape and you are guaranteed that no personally identifiable information will be linked to your recorded responses. (Turn on tape recorder.)

Interview Questions

• 1. How would you describe your practice of medicine? Probe if necessary: for example private practice, hospital, medical school

• 2. Do you communicate with your patients via email? Probe: Why or why not?

• 3. Does your practice use electronic medical records? Probe: Why or why not?

• 4. How many days a week do you schedule patient appointments?

• 5. How many patients do you see each week?

• 6. What does the phrase “patient health literacy” mean to you? Probe: Are you concerned about your patients’ health literacy?

• 7. List the steps you follow when interacting with a patient from the time you enter the examination room until you exit the room. Probe for tools: Do you use a computer in the examining room? Do you use medical instruments such as blood pressure monitor, stethoscope, ear scope, tongue suppressor? Do you reference their medical record, lab results, diagnostic tests results? Do you talk to the patient? Do you talk to the patient’s family if they are present? Do you record information into their medical record?

• 8. What is the main focus of your activity during the patient’s examination in the steps you listed above? Probe if needed: the patient, the patient’s health, diagnosis of the problem, other?

• 9. What is the main result or outcome you hope to have achieved when you exit the patient examination room? Probe: If more than one is mentioned.

• 10. In the past 7 days have any of your patients brought health information they found on the internet to their examination? (If no, then past 30 days? If no, then past 60 days? If no then omit questions 11 and 12.)

• 11. (If yes in #10 then ask), Was the health information your patient found on the internet directly related to their disease or health condition?

• 12. Did you discuss the information with your patient?

• 13. (If yes in #12 then ask), Where did the discussion occur in the steps outlined in the generic patient examination activity above?

• 14. How many employees other than physicians do you work with in your practice?

• 15. What are the titles of these employees? (Probe: i.e. nurses, nurse practitioners, physician’s assistants, administrative assistants, medical technologists?)

• 16. How do these other employees support the activity of examining patients?

• 17. Does your practice have a policy to refer patients to internet health information? (If no, omit questions 18 and 19.)

• 18. (If yes in #17 then ask),Who is designated to refer the patient to internet health information in your practice? Probe: Where/How does this occur? During examination, after examination, follow-up visit, sent to patient later?

• 19. In what format do they give the suggested resources to the patient? (Probe: word document?, brochure?, email attachment?, information prescription?)

• 20. Other than local, state, HIPAA and other federal laws what additional rules, guidelines, policies or procedures are you expected to follow when examining patients?

I would also like to ask you a few more questions to allow me to better understand the characteristics of my interviewees.

• 21. In what year were you born?

• 22. In what year did you start practicing medicine?

(Questions for the interviewer to answer by observation if possible)

• 23. What is the interviewee’s gender?

• 24. What is interviewee’s race?

Thank you for agreeing to participate in this interview. (Ask if they would be willing to complete a brief online survey in the future relating to internet health information. If so, then ask them for their email address to send them the survey link or give them a printed copy of the survey link on the signed confidentiality form.)