Clinicians confront formidable challenges with information management and coordination activities. When not properly integrated into clinical workflow, technologies can further burden clinicians’ cognitive resources, which is associated with medical errors and risks to patient safety. An understanding of workflow is necessary to redesign information technologies (IT) that better support clinical processes. This is particularly important in surgical care, which is among the most clinical and resource intensive settings in healthcare, and is associated with a high rate of adverse events. There are a growing number of tools to study workflow; however, few produce the kinds of in-depth analyses needed to understand health IT-mediated workflow. The goals of this research are to: (1) investigate and model workflow and communication processes across technologies and care team members in post-operative hospital care; (2) introduce a mixed-method framework, and (3) demonstrate the framework by examining two health IT-mediated tasks. This research draws on distributed cognition and cognitive engineering theories to develop a micro-analytic strategy in which workflow is broken down into constituent people, artifacts, information, and the interactions between them. It models the interactions that enable information flow across people and artifacts, and identifies dependencies between them. This research found that clinicians manage information in particular ways to facilitate planned and emergent decision-making and coordination processes. Barriers to information flow include frequent information transfers, clinical reasoning absent in documents, conflicting and redundant data across documents and applications, and that clinicians are burdened as information managers. This research also shows there is enormous variation in how clinicians interact with electronic health records (EHRs) to complete routine tasks. Variation is best evidenced by patterns that occur for only one patient case and patterns that contain repeated events. Variation is associated with the users’ experience (EHR and clinical), patient case complexity, and a lack of cognitive support provided by the system to help the user find and synthesize information. The methodology is used to assess how health IT can be improved to better support clinicians’ information management and coordination processes (e.g., context-sensitive design), and to inform how resources can best be allocated for clinician observation and training.

The current study was a benefit cost analysis that examined mental and behavioral health and prescription drug service use data of 347 participants (212 youth and 135 caregivers) from a bereavement intervention, the Family Bereavement Program (FBP).The preliminary goals of the current study were to compare the FBP intervention and the Literature Control (LC) groups at the six year follow-up on: (a) number of participants using mental/behavioral health services and prescription drugs, (b) the frequency of use of mental/behavioral health services and prescription drugs, and (c) the costs of mental/behavioral health services and prescription drugs. The final, and primary goal, was to (d) calculate the benefits of the FBP by analyzing the monetary difference between the LC and FBP groups in terms of cost of services used and then by applying those benefits to the cost of the intervention. Data representing participating youths' and caregivers' mental health service use and prescription drug use at the sixth year post-intervention were collected, as were the costs of those services. Results indicated that fewer FBP participants used services and prescription drugs than the Literature Control (LC) participants, but FBP participants, particularly the youth, used some low intensity services more frequently whereas the LC youth used more intensive and costly services more frequently. Consequently, service costs were greater for participants in the LC group than for participants in the FBP group. The benefit cost ratio revealed that the FBP, as delivered, saved society between $.15 and $.27 in mental and behavioral health costs for every dollar spent on the intervention. Implications of these findings and directions for future research are discussed.