Health IT Practice Redesign

Overview: Health IT systems are expected to significantly improve quality of care. By supporting clinicians, these systems create new processes and workflows. To properly implement health IT in practice redesign, a deep understanding of the interaction between health IT and workflow is essential. Studies show that failure to properly consider an organizations’ work processes can lead to many unintended consequences. These consequences may potentially compromise patient safety. A thorough analysis of work processes are required pre- and post-health IT implementation, however, workflow issues are continually listed as barriers to health IT implementation, adoption, and use.

Most of the relevant literature relies on informal or under-specified data to assess whether or not health IT has had an impact on workflow. The gaps and limitations of existing research limit the relevance and quality of the available evidence for healthcare organizations wishing to implement health IT systems. Likewise, the existing evidence has been of equally limited utility to those organizations seeking to use health IT systems to redesign their ambulatory care settings.

Aims: The purpose of this contract was to study the use of health IT in ambulatory care practices as well as its impact on patient and provider workflow.

Final report: Patient-Reported Health IT and Workflow

The following are partners on this contract:
Abt Associates
APBRN Coordinating Center

Funding: Agency for Healthcare Research and Quality (AHRQ)

Pascale Carayon, PhD
Procter & Gamble Bascom Professor in Total Quality
Department of Industrial and Systems Engineering
Director, Center for Quality and Productivity Improvement
University of Wisconsin-Madison

Peter Hoonakker, PhD
Research Scientist, Associate Director of Research
Center for Quality and Productivity Improvement
University of Wisconsin-Madison

Randi Cartmill, MS
Researcher, Center for Quality and Productivity Improvement
University of Wisconsin-Madison


Hoonakker, P.L.T., Carayon, P., Cartmill, R.S. (2017). The impact of secure messaging on workflow in primary care: Results of a multiple-case, multiple-method study. International Journal of Medical Informatics 100: pp. 63-76. PMID: 28241939


Hoonakker, P.L.T., Cartmill, R. & Carayon, P. (2016). Impact of electronic forms for patients on workflow in primary care. In Mollo, V. and Falzon, P. (Ed), Proceedings of the Healthcare Systems Ergonomics and Patient Safety Conference.Toulouse, France, October 5-7, 2016, pp. 190-195.

Wooldridge, A.R., Carayon, P., Hoonakker, P.L.T., Musa, A., Bain, P. (2016). Technology-mediated communication between patients and primary care clinicians and staff: Ambiguity in secure messaging. Paper presented at the HFES conference 2016, Washington, D.C., September 19-23, 2016.


Carayon, P., Hoonakker, P. L., Cartmill, R., Hassol, A. (2015). Using Health Information Technology (IT) in Practice Redesign: Impact of Health IT on Workflow. Patient-Reported Health Information Technology and Workflow. (Prepared by Abt Associates under Contract No. 290-2010-00031I). AHRQ Publication No. 15-0043-EF. Rockville, MD: Agency for Healthcare Research and Quality. May 2015.


Hoonakker, P.L.T., Cartmill, R.S., Carayon, P., Deitz, D., Bain, P., Musa, A., Hassol, A., (2014). Patients providing information through the patient portal and the impact on primary care practice workflow: The first results. Paper presented at the I-Practice Conference, Madison, WI, March 9-11, 2014.

Wetterneck, T.B., Kelly, M., Carayon, P., Sesto, M., Tevaarwerk, A., Chui, M., Stone, J., Hoonakker, P.L.T., Musa, A. (2014). Healthcare Collaborations: Improving Quality and Safety through a Team and Systems Engineering Approaches. Proceedings of the HFES Conference, Chicago, IL, Oct 27-31, 2014, pp. 728-732.