Barriers to effective clinician–patient outcome feedback that can be addressed by health information technology (IT)
| Barriers to feedback | Features of potential health IT solutions |
| Barriers specific to fragmented healthcare systems | |
| No consistent process for exchange of patient information for purposes of feedback across care settings and healthcare organisations | Allows for automated or semiautomated processes to deliver feedback between care settings and clinician groups |
| Lack of interoperability between different EHR platforms that hinder information exchange16 | Health information exchanges can be leveraged to serve as a common platform between different EHR systems for purposes of feedback creation and delivery |
| Minimal infrastructure dedicated to sharing patient information across all clinicians involved in the care of a patient17 | Health IT underpinning other existing care delivery infrastructure (eg, EHRs) can be adapted for the purpose of sharing patient outcomes |
| Barriers common to all healthcare systems | |
| Structural barriers | |
| Lack of resources to keep track of appropriate timing for feedback, correct feedback recipients/sources, and clinician contact information6 13 14 | Automatically identifies appropriate feedback timeframe, correct feedback recipients, clinician contact information and manner of feedback delivery |
| Lack of time to conduct follow-up activities (eg, review EHR, seek out accepting clinicians) or provide feedback13 14 | Supports a feedback system that is well integrated into clinicians' workflow to minimise effort required in delivering, receiving and processing feedback |
| Unreliable feedback delivery (eg, sent to the wrong clinician or address, delay with mailed letters)12 | Supports electronic delivery of feedback to the correct clinician at the right time; can track delivery and receipt of feedback |
| Difficulty in delivering feedback on outcomes of individual patients (as opposed to aggregated patient data)12 | If linked to existing EHR systems, capable of delivering feedback regarding individual patients |
| No clear guidelines as to content and manner of providing feedback, resulting in variable quality of communication14 | Content and manner of generating and delivering feedback may be standardised to an extent given specific clinical settings or situations |
| Data security risks when delivering feedback especially to clinicians across organisations14 | Can help maintain compliance with patient privacy laws by ensuring that information is received only by the intended recipient and data security is maintained throughout the feedback process |
| Psychological barriers | |
| Reliance on individual motivations of upstream clinician to seek feedback (eg, clinical uncertainty, personal affinity for patient, concern for patient vulnerability)13 | Does not rely on clinician motivations to generate and deliver feedback; since able to deliver feedback for all patients, can provide a more accurate perspective of clinicians' performance. Health IT-supported feedback systems championed by strong leadership promotes a culture that expects clinicians to deliver and anticipate feedback |
| Expectation of upstream clinician that they will automatically receive feedback if something untoward happens to the patient6 | Changes expectations to that of universal feedback to clinicians for all patients, that is, no news is not good news |
| Perception of downstream clinicians that feedback is not effective or irrelevant to upstream clinicians15 | Supports electronic methods to measure impact of feedback on certain behaviours of upstream clinicians (eg, reaccess of EHR after feedback is received); supports methods to collect data regarding upstream clinicians' perceptions of feedback; supports communication between clinicians for further discussion |
| Interpersonal barriers | |
| Fear of possible conflict/retaliation and damage to professional relationships if negative feedback is delivered14 15 | Mitigates conflict by normalising feedback through consistent delivery |
| Fear of medicolegal risks that may be incurred by upstream clinician14 | Health IT-supported feedback systems can become an institutional norm and encourage clinicians to communicate in other ways to deepen mutual trust; communication between clinicians can potentially be incorporated into a quality improvement process, which may confer confidentiality and ‘peer-review privilege’ depending on applicable federal/state laws |
EHR, electronic health record.