Impact of information and communication software on multiprofessional team collaboration in outpatient palliative care – a qualitative study on providers’ perspectives

The interviews provided a variety of interesting results which, due to their complexity, cannot all be discussed in one publication. For this reason, we limit ourselves in this manuscript to collaboration in a multiprofessional team.

Based on the analysis, we were able to capture the following three core findings, which include a focus on the different effects a new communication tool like ISPC has on the collaboration in multiprofessional teams in palliative care: delegation of tasks, improvement of team collaboration, and improvement of working conditions.

Furthermore, we can add that the software is primarily used in outpatient palliative care, as this software facilitates exchange during home visits by different teams. In the hospital where it has been used, the software was used as an “add-on” alongside the traditional documentation software to document palliative cases.

Delegation of tasks

Physicians reported a broader variety of delegating tasks. The software simplifies the delegation of tasks by utilizing its accessibility for every provider involved. In addition, the software enables simple and quickly available task distribution with the help of so-called to-dos, including traceability of completion and written, traceable arrangement. The traceability of the documentation is granted, so that it can be recognized which person has distributed or ordered tasks, which person has completed them, as well as which data has been entered by whom. This provides judicial security (e.g., regarding the administration of medication):

Footnote 4PCTP-03 – Palliative care nurse: “Well, what’s good is that you have the delegation […], i.e. the doctor’s order, right in the system. So what you were familiar with in the past […] we no longer have that, of course, because they document it immediately and it is also verifiable in the system in a data-proof manner, right? That is of course a great advantage.”

PCTP-02 – Palliative care nurse: “And above all, I can also directly carry out doctors’ orders that I can see online. If I tell myself I’ll only do it with an order, which I’m actually only allowed to do as a nurse. And of course, it’s much faster.”)

PA-06 – General practitioner: “Communication is much easier. In other words, I don’t have to make phone calls about every little thing. I can delegate things and see that they are done. So I don’t have to laboriously follow up again, ask, ‘Did you do that too?”

Altogether, we can see that information and communication technologies simplify the communication and task management between the providers and decrease unnecessary supervision of duties and responsibilities.

Improvement of team collaboration

As we could see, participants essentially used the main function of the software, and it was well accepted that easy transfer of patient data to other providers is possible if they also use the same software. Patient data can be easily shared instead of having to be obtained in a time-consuming manner:

PA-03 – General practitioner: “We can exchange ideas, right? The best example: my colleague went on vacation and handed over his patients to me. So the, what should I say, problem children. And then, when there were actually corresponding inquiries, I was able to see his entries immediately, to understand them, and to see them more or less immediately without any, what should I say? Loss in communication or in empathy immediately to continue his work with these patients.”

As well it is possible that all providers share the same knowledge:

PCTA-02 – Palliative care doctor: “[…] We have the possibility via the software to see at all times: who was involved and when, and what has changed in the perception? And even if, under certain circumstances, we are no longer responsible for the support, for example, if we transfer the patient to an inpatient setting or if the patient has died, we still have the opportunity to check this evaluation via the individual case documentation: How did it develop? What was our perception at the beginning? How is it now? So I think this is an important tool for the quality of the work.”

Additionally, the pharmacist we interviewed confirmed the benefits a web-based rapid exchange provides:

AP-01 – Pharmacist: “And, of course, there are also some intolerances to medications, which are also entered. That’s another double check for me, to see: Has this now perhaps been prescribed by mistake? […] We sometimes have cases where patients do not want to accept this box at all […]. And then they say ‘I don’t want to’, then I can make a note ‘Patient has refused to accept’. If the doctor has to go out at night and the things [medicaments] are not there, that would be annoying […].”

Improvement of working conditions

The simultaneous access of different providers allows simple communication between them and avoids additional often time-consuming work (e.g., secondary phone calls). Paper documentation is no longer necessary – the software eliminates the need to search through paper folders and facilitates the retrieval of information:

HP-05 – Hospice nurse: “ISPC has made things much easier, so the general level of information in the team is higher as a result. And you can also trust that your colleagues know what’s going on. And you can also just rely on it and say, ‘Well, just take a look at ISPC,‘ right? Especially because we are also on call and then one colleague is responsible for all our patients at night.”

This yields improved collaboration among stakeholders:

PA-03 – General practitioner: “Yes, the collaboration between us has improved significantly in so far as we can enter our data there in the traditional way and, if I’m on the road somewhere or whatever, I can access it immediately with my terminal device and see if I’m on call, let’s say and I’m called to a patient I don’t know personally, then I can see very quickly what’s happened there without having to call my colleague first (…). And the improvements keep coming up - whether it’s the standard of medications or the faster contact with the pharmacy - that’s going wonderfully, has improved significantly the communication with each other.”

Since the software is web-based, it can be used regardless of location, and users can access it from anywhere – whether an internet connection is available, and the software is used on a laptop, smartphone, or tablet. However, if there is no internet, poor access, or the software is only used on a desktop computer, slow or no mobile access to the data is possible:

PCTP-03 – Palliative care nurse: “And that is 1:1 documentation, I can now read what my colleague agreed with the patient 10 minutes ago 50 kilometers away. That’s great.”

PCTP-04 – Palliative care nurse: “And being able to network was of course a big achievement. And the major advance was that it was web-enabled, that I could access it from anywhere, that the data was secure, and that I was always up to date, even if I wasn’t going to meet in person. And that, I guess, was convincing right from the start.”

Based on the information in the software, communication with patients and relatives can be facilitated; since atmospheric and other relevant information can be entered in addition to medical parameters (e.g., access routes; aggressive pets; difficult family situations, etc.).

HP-01 – Hospice nurse: “And that is incredibly valuable, so there has really been a change compared to before because we often had very little information about the patient. Or it is always like this: What they tell us is perhaps something different than what they tell the doctor, and sometimes it is simply important to know more about this medical situation.”

It also streamlines vacation handoffs between physicians, making it easy to refer to what patients need:

PA-03 – General practitioner: “We had this case with vacation replacement, a very seriously ill 19-year-old girl. Mr. [name] was the palliative physician primarily responsible but then went on vacation. I was in charge and was able to see extremely quickly on the basis of the program - or on the basis of the entries, I might say - where the problems were. Not only cancer and the resulting complaints, but also the social environment, which was difficult. Who is my contact person? Where could there be problems in communication, also in the understanding of the disease? No, these are definitely the advantages of the program.”

The wealth of information in the software enables nurses to act quickly, even in acute situations, as all relevant information is ideally already available:

PCTP-02 – Palliative care nurse: “And, of course, it’s much faster. So for our office staff, who of course have no medical training, if I see that I need it now and I need it right now, then I don’t have to wait three hours until I come back to the office to write a prescription, but I can do it all without a phone. Even if I can’t reach anyone right now, I can enter it into the system and by the time I get back, it’s already processed and ready.”

In addition, the information is also immediately transcribed and can thus be read without any detours or communication problems:

PCTP-06 – Palliative care nurse: “Well, there are advantages, of course, if I’m at the patient’s home at night, for example, and on the basis of our needs plan, which is on-site as a paper, the medication is simply no longer sufficient, and I call the palliative care physician and he makes a change, which he immediately enters in the ISPC, and I can then login and check within a few minutes and am then immediately ready to act. That’s great, of course. Of course, you can also do it by phone, but especially when it comes to narcotics, it’s nice to have it written down.”

Finally: The nurses appreciate that instructions are written down and that work steps remain comprehensible:

PCTP-03 – Palliative care nurse: “Well, what’s good is that you have the delegation, i.e., the medical order, right in the system. So, what you know from the past, when you agreed on things by phone with the medical colleagues, that you have to have it countersigned the next time they are there, or that you have to document the verbal order and read it out again and document, read out and approved. Of course, we don’t have that anymore, because they document it immediately and it is also verifiable in the system.”

Altogether, we can see that the software enables faster communication and delegation of tasks. Therefore, it allows facilitating the collaboration between multiprofessional teams that work independently of each other but care for the same patients. All providers have the same knowledge about their patients without having to dial each other or search for the information in disorganized paper documentation.

On the other hand, there were also difficulties in using the software, so the interviewed participants sometimes did not know that they could also use the software on mobile devices, or the internet connection, especially in rural areas, was not always available.

PfP-01 – Nurse: “It’s a pity that we only have access from the office. It would be better if the employees who are directly on-site with the patient could use ISPC immediately.”

PCPT-01 – Palliative care nurse: “Well, sometimes we don’t have a stable Internet connection here, and when it breaks down in the middle of documenting or with the iPad […]. And if I then have to document a second time because it didn’t take over the first time or didn’t save properly - yes, that’s annoying sometimes.”

These unexpected negative aspects show the software’s flaws which point to operating errors. The poor internet connectivity can also be bypassed by using an offline mode. The reason that we did not expect these results is that the software developers offer training on how to use the software, and we assumed that all users would take advantage of this training.

In addition, the physicians from the clinic and a nurse from a private practice mentioned that another internal documentation software was also used, resulting in double documentation.

In conclusion, there were not many negative aspects, as participants described the software as self-explanatory and easy to use. When asked about data protection, no negative aspects were mentioned either, as the software was perceived as consistently secure.

Nonetheless, all participants reported regular meetings with each other to actively share ongoing cases, even when tasks and procedures could be communicated through the software.

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