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Abstract
Although the presence of an electronic health record (EHR) alone does not ensure high quality, efficient care, few studies have focused on the work of those charged with optimising use of existing EHR functionality. To examine the approaches used and challenges perceived by analysts supporting the optimisation of primary care teams' EHR use at a large U.S. academic health care system. A qualitative study was conducted. Optimisation analysts and their supervisor were interviewed and data were analysed for themes. Analysts needed to reconcile the tension created by organisational mandates focused on the standardisation of EHR processes with the primary care teams' demand for EHR customisation. They gained an understanding of health information technology (HIT) leadership's and primary care team's goals through attending meetings, reading meeting minutes and visiting with clinical teams. Within what was organisationally possible, EHR education could then be tailored to fit team needs. Major challenges were related to organisational attempts to standardise EHR use despite varied clinic contexts, personnel readiness and technical issues with the EHR platform. Forcing standardisation upon clinical needs that current EHR functionality could not satisfy was difficult. Dedicated optimisation analysts can add value to health systems through playing a mediating role between HIT leadership and care teams. Our findings imply that EHR optimisation should be performed with an in-depth understanding of the workflow, cognitive and interactional activities in primary care.
Highlights
In the United States, there is increasing recognition that the presence of an electronic health record (EHR) does not assure high quality and efficient care.[1,2,3,4] Understanding how EHRs are used within the clinical context is critical to achieving improvements in care.[5,6] The 2009 American Reinvestment and Recovery Act contained significant incentives for EHRs in its Health Information Technology for Economic and Clinical Health Act (HITECH) Act provisions.[7]
Analysts needed to reconcile the tension created by organisational mandates focused on the standardisation of EHR processes with the primary care teams’ demand for EHR customisation
They gained an understanding of health information technology (HIT) leadership’s and primary care team’s goals through attending meetings, reading meeting minutes and visiting with clinical teams
Summary
In the United States, there is increasing recognition that the presence of an electronic health record (EHR) does not assure high quality and efficient care.[1,2,3,4] Understanding how EHRs are used within the clinical context is critical to achieving improvements in care.[5,6] The 2009 American Reinvestment and Recovery Act contained significant incentives for EHRs in its Health Information Technology for Economic and Clinical Health Act (HITECH) Act provisions.[7] These incentives require clinicians and hospitals to demonstrate the use of certified EHR technology in ways that require significant changes in care processes. The presence of an electronic health record (EHR) alone does not ensure high quality, efficient care, few studies have focused on the work of those charged with optimising use of existing EHR functionality. Optimisation analysts and their supervisor were interviewed and data were analysed for themes.
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