Comprehensive process model of clinical information interaction in primary care: Results of a "best-fit" framework synthesis

Tiffany C. Veinot, Charles R. Senteio, David Hanauer, Julie C. Lowery

Research output: Contribution to journalReview articlepeer-review

4 Scopus citations


Objective: To describe a new, comprehensive process model of clinical information interaction in primary care (Clinical Information Interaction Model, or CIIM) based on a systematic synthesis of published research. Materials and Methods: We used the "best fit" framework synthesis approach. Searches were performed in PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Library and Information Science Abstracts, Library, Information Science and Technology Abstracts, and Engineering Village. Two authors reviewed articles according to inclusion and exclusion criteria. Data abstraction and content analysis of 443 published papers were used to create a model in which every element was supported by empirical research. Results: The CIIM documents how primary care clinicians interact with information as they make point-of-care clinical decisions. The model highlights 3 major process components: (1) context, (2) activity (usual and contingent), and (3) influence. Usual activities include information processing, source-user interaction, information evaluation, selection of information, information use, clinical reasoning, and clinical decisions. Clinician characteristics, patient behaviors, and other professionals influence the process. Discussion: The CIIM depicts the complete process of information interaction, enabling a grasp of relationships previously difficult to discern. The CIIM suggests potentially helpful functionality for clinical decision support systems (CDSSs) to support primary care, including a greater focus on information processing and use. The CIIM also documents the role of influence in clinical information interaction; influencers may affect the success of CDSS implementations. Conclusion: The CIIM offers a new framework for achieving CDSS workflow integration and new directions for CDSS design that can support the work of diverse primary care clinicians.

Original languageEnglish (US)
Pages (from-to)746-758
Number of pages13
JournalJournal of the American Medical Informatics Association
Issue number6
StatePublished - Jun 1 2018

All Science Journal Classification (ASJC) codes

  • Health Informatics


  • Clinical decision support
  • Information use
  • Information-seeking behavior
  • Primary care informatics
  • Theoretical model

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