Current Electronic Health Record Research Articles

Back to the Bedside: Developing a Bedside Aid for Concussion and Brain Injury Decisions in the Emergency Department.

Context:Current information-rich electronic health record (EHR) interfaces require large, high-resolution screens running on desktop computers. This interface compromises the provider’s already limited time at the bedside by physically separating the patient from the doctor. The case study presented here describes a patient-centered clinical decision support (CDS) design process that aims to bring the physician back to the bedside by integrating a patient decision aid with CDS for shared use by the patient and provider on a touchscreen tablet computer for deciding whether or not to obtain a CT scan for minor head injury in the emergency department, a clinical scenario that could benefit from CDS but has failed previous implementation attempts.Case Description:This case study follows the user-centered design (UCD) approach to build a bedside aid that is useful and usable, and that promotes shared decision-making between patients and their providers using a tablet computer at the bedside. The patient-centered decision support design process focuses on the prototype build using agile software development, but also describes the following: (1) the requirement gathering phase including triangulated qualitative research (focus groups and cognitive task analysis) to understand current challenges, (2) features for patient education, the physician, and shared decision-making, (3) system architecture and technical requirements, and (4) future plans for formative usability testing and field testing.Lessons Learned:We share specific lessons learned and general recommendations from critical insights gained in the patient-centered decision support design process about early stakeholder engagement, EHR integration, external expert feedback, challenges to two users on a single device, project management, and accessibility.Conclusions:Successful implementation of this tool will require seamless integration into the provider’s workflow. This protocol can create an effective interface for shared decision-making and safe resource reduction at the bedside in the austere and dynamic clinical environment of the ED and is generalizable for these purposes in other clinical environments as well.

What makes an EHR "open" or interoperable?

We have identified 5 use cases that comprise a useful definition of an "open or interoperable electronic health record (EHR)." Each of these use cases represents important functionality that should be available to 1) clinicians, so they can provide safe and effective health care; 2) researchers, so they can advance our understanding of disease and health care processes; 3) administrators, so they can reduce their reliance on a single-source EHR developer; 4) software developers, so they can develop innovative solutions to address limitations of current EHR user interfaces and new applications to improve the practice of medicine; and 5) patients, so they can access their personal health information no matter where they receive their health care. Widespread access to "open EHRs" that can accommodate at least these 5 use cases is important if we are to realize the enormous potential of EHR-enabled health care systems.

Continuity and Darwinism-Natural Selection, Extinction, or Adaptation.

Continuity and Darwinism-Natural Selection, Extinction, or Adaptation.

Can Health Care Survive Current Electronic Health Record Usability?

Can Health Care Survive Current Electronic Health Record Usability?

Clinical Decision Support in the Pediatric Hospital Setting

The electronic health record (EHR) is a key component in the delivery of healthcare in most hospitals in the USA today. Current EHR systems have evolved from simple databases for basic administrative and patient information to complex systems that are also capable of storing clinical documentation, laboratory results, and radiologic images, as well as transmitting patient care orders throughout a hospital’s various departments and systems. Within the EHR, clinical decision support (CDS) tools have the potential to help improve patient care by standardizing practice, reducing errors, and aiding diagnostic and therapeutic decision-making. In the pediatric hospital setting, CDS tools can deliver pediatric-specific information and guidance on disease management through alerts, computerized provider order entry and order sets, and clinical practice guidelines. These various CDS functions are of great importance to the practice of safe, high-quality patient care and learning to maximize their potential is of great benefit to clinicians. At the same time, these tools must be implemented in a manner consistent with established CDS best practices to prevent potential unintended consequences that introduce new sources of error and potential harm.

Designing a patient-centered user interface for access decisions about EHR data: implications from patient interviews.

Electronic health records change the landscape of patient data sharing and privacy by increasing the amount of information collected and stored and the number of potential recipients. Patients desire granular control over who receives what information in their electronic health record (EHR), but there are no current patient interfaces that allow them to record their preferences for EHR access. Our aim was to derive the user needs of patients regarding the design of a user interface that records patients' individual choices about who can access data in their EHRs. We used semi-structured interviews. The study was conducted in Central Indiana. Thirty patients with data stored in an EHR, the majority of whom (70 %) had highly sensitive health EHR data, were included in the study. We conducted a thematic and quantitative analysis of transcribed interview data. Patients rarely knew what data were in their EHRs, but would have liked to know. They also wanted to be able to control who could access what information in their EHR and wanted to be notified when their data we re accessed. We derived six implications for the design of a patient-centered tool to allow individual choice in the disclosure of EHR: easy patient access to their EHRs; an overview of current EHR sharing permissions; granular, hierarchical control over EHR access; EHR access controls based on dates; contextual privacy controls; and notification when their EHRs are accessed.

How to Choose or Change an Electronic Health Record System

Nurse practitioners across the United States use or are about to use electronic health record (EHR) systems while having minimal input into EHR purchase decisions. The EHR system can affect provider and patient satisfaction, reimbursement, and other aspects of practice. Most EHR planning tools focus on hardware and software needs, rather than the process used to identify the right product; however, the EHR may fail if an inappropriate process is used. Ten elements essential to purchase and implement an EHR system and the steps to take if the current EHR does not meet practice needs are reviewed.

Electronic health records: effects of clutter and stress on physicians’ information search and noticing performance

Electronic health records (EHRs) in emergency departments (EDs) store and display important medical information and thus play a critical role in medical diagnoses. However, current EHR designs often result in display clutter, a condition where a large amount of poorly organized information is displayed. This can cause delays in finding and noticing relevant information. Clutter may be especially problematic under conditions of stress, which is known to degrade people’s perceptual capacities. The goal of this study was to analyze the effects of EHR clutter and stress on physicians’ ability to search for and notice important information during medical diagnosis procedures. Three simulated EHR pages were developed for this study. Participating physicians were presented with typical ED patient scenarios and the relevant EHR page for each patient. They were required to search the EHR displays to answer a specific question related to each patient and, based on their review of the EHR, they had to confirm or refute a proposed diagnosis. Performance measures and subjective feedback were collected. In general, results showed that clutter increased the time to find a given search target and the time to extract important information, as well as the number of missed targets. The effects of clutter were most pronounced for the EHR page that displayed unorganized lists of medical data, where the presence of stress also exacerbated the effects of clutter on response time. These results emphasize the need to develop display countermeasures to overcome the effects of display clutter in hospital as well as other environments.

The utah beacon experience: integrating quality improvement, health information technology, and practice facilitation to improve diabetes outcomes in small health care facilities.

Purpose:The Utah Improving Care through Connectivity and Collaboration (IC3) Beacon community (2010–2013) was spearheaded by HealthInsight, a nonprofit, community-based organization. One of the main objectives of IC3 was to improve health care provided to patients with diabetes in three Utah counties, collaborating with 21 independent smaller clinics and two large health care enterprises. This paper will focus on the use of health information technology (HIT) and practice facilitation to develop and implement new care processes to improve clinic workflow and ultimately improve patients’ diabetes outcomes at 21 participating smaller, independent clinics.Innovation:Early in the project, we learned that most of the 21 clinics did not have the resources needed to successfully implement quality improvement (QI) initiatives. IC3 helped clinics effectively use data generated from their electronic health records (EHRs) to design and implement interventions to improve patients’ diabetes outcomes. This close coupling of HIT, expert practice facilitation, and Learning Collaboratives was found to be especially valuable in clinics with limited resources.Findings:Through this process we learned that (1) an extensive readiness assessment improved clinic retention, (2) clinic champions were important for a successful collaboration, and (3) current EHR systems have limited functionality to assist in QI initiatives. In general, smaller, independent clinics lack knowledge and experience with QI and have limited HIT experience to improve patient care using electronic clinical data. Additionally, future projects like IC3 Beacon will be instrumental in changing clinic culture so that QI is integrated into routine workflow.Conclusion and Discussion:Our efforts led to significant changes in how practice staff optimized their EHRs to manage and improve diabetes care, while establishing the framework for sustainability. Some of the IC3 Beacon practices are currently smoothly transitioning to new models of care such as Patient-Centered Medical Homes. Thus, IC3 Beacon has been instrumental in creating a strong community partnership among various organizations to meet the shared vision of better health and lower costs, and the experience over the last few years has helped the community prepare for the changing health care landscape.

Approaches and challenges to optimising primary care teams' electronic health record usage

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.

Informatics: International Classification of Diseases-10: Implications for Nursing

One of the biggest events to hit healthcare data in decades is the conversion of coded clinical data to the International Statistical Classification of Diseases and Related Health Problems: Tenth Revision, commonly referred to as ICD-10. The last change of this nature was in 1983 when Medicare implemented ICD-9 as part of the Inpatient Prospective Payment System (IPPS). Since that time, healthcare has advanced significantly and ICD-9 codes no longer represent the advances and complexities in care provided to patients; thus healthcare in the United States is expected to transition to ICD-10 on October 1, 2015.ICD-10 is intended to support the systematic recording, analysis, interpretation, and comparison of morbidity and mortality data from around the world (World Health Organization, 2011). There are two parts to ICD-10: ICD-10Clinical Modification (CM) and ICD-10- Procedure Coding System (PCS). Compared to ICD-9-CM with 14,000 codes, ICD-10-CM has 69,000 available codes to be used for diagnosis codes on all inpatient and outpatient accounts. In ICD-9-PCS there are approximately 3,000 codes; this will change with ICD-10-PCS to 72,000 available codes to be used only for inpatient procedural coding.ICD-10 will touch everything from registration and scheduling, to revenue cycle and payer contracts, information systems, and ultimately will be used to improve patient care and outcomes. The important and widespread uses of ICD-10 data make it critical to understand these new documentation requirements. As healthcare prepares for ICD-10 and the coding of data using an electronic platform, it is important to ask, What are the implications for nursing? Although the answer to this question is not easily found, this informatics column will shed light on the issue by providing a sample case and highlighting the role of nurse informaticists in this historical change in healthcare data. We will conclude that nursing's role in data collection and entry is important in the building of the ICD-10 database, and that the benefits to be achieved from this monumental effort are dependent on accurate documentation and coding.Sample Case: Pressure UlcerPressure ulcer was chosen as a sample case to examine in this column due to the costs incurred in treating pressure ulcers. It was also chosen based on the historical precedent whereby staging of pressure ulcers has been coded in ICD-9-CM from nursing charting/documentation (.Cfin.ters..fQr-MlfidLcare-&jyiadicai,d..S.er.v:ic.es.l[CMS3-& .N,ati.Q.n.aL.Cen.ter for Health ..Statistics LN.CHS.].,. 2.Q.Q.S).MethodThe following steps were used to identify nursing documentation needs for pressure ulcers related to ICD-10.1. Define pressure ulcers.2. Download the ICD-10-CM codes and identify all diagnoses related to pressure ulcers.3. Identify the data elements, i.e., the words used, in the pressure ulcer diagnoses in ICD-10-CM codes.4. Identify related data elements in the current electronic health record (EHR) nursing documentation on pressure ulcers.5. Perform a gap analysis between current EHR documentation by nurses on pressure ulcers and what is needed for nursing documentation in ICD-10-CM.6. Reconcile findings with other databases using nursing documentation on pressure ulcers in short-stay hospitals.7. Collaborate with health information management (HIM) to validate findings.8. Present findings to Chief Nursing Officers, as well as wound care nurses and physical therapists.9. Work with information technology EHR builders to build the data base related to ICD-10-CM that is needed for nurses to document in the EHR.10. Prepare educational materials for staff nurses regarding the changes in pressure ulcer documentation for ICD-10-CM.11. Pilot education materials among staff nurses, making adjustments as needed.12. Disseminate educational materials/offerings regarding nursing documentation of pressure ulcers related to ICD-10-CM. …

Enabling Quality

The Health Resources and Services Administration has supported the adoption of electronic health records (EHRs) by federally funded health centers for over a decade; however, little is known about health centers' current EHR adoption rates, progress toward Meaningful Use, and factors related to adoption. We analyzed cross-sectional data from all 1,128 health centers in 2011, which served over 20 million patients during that year. As of 2011, 80% of health centers reported using an EHR, and high proportions reported using many advanced EHR functionalities. There were no indications of disparities in EHR adoption by census region, urban/rural location, patient sociodemographic composition, physician staffing, or health center funding; however, there were small variations in adoption by total patient cost and percent of revenue from grants. Findings revealed no evidence of a digital divide among health centers, indicating that health centers are implementing EHRs, in keeping with their mission to reduce health disparities.

Electronic health record functionality needed to better support primary care.

Electronic health records (EHRs) must support primary care clinicians and patients, yet many clinicians remain dissatisfied with their system. This article presents a consensus statement about gaps in current EHR functionality and needed enhancements to support primary care. The Institute of Medicine primary care attributes were used to define needs and meaningful use (MU) objectives to define EHR functionality. Current objectives remain focused on disease rather than the whole person, ignoring factors such as personal risks, behaviors, family structure, and occupational and environmental influences. Primary care needs EHRs to move beyond documentation to interpreting and tracking information over time, as well as patient-partnering activities, support for team-based care, population-management tools that deliver care, and reduced documentation burden. While stage 3 MU's focus on outcomes is laudable, enhanced functionality is still needed, including EHR modifications, expanded use of patient portals, seamless integration with external applications, and advancement of national infrastructure and policies.

Patient-Physician Interactions and Electronic Health Records

To the Editor In their recent Viewpoint, Drs White and Danis 1 discussed using the electronic health record (EHR) to enhance patient-physician interactions. Whereas others have argued that the EHR can hinder patient-physician communication, 2 the authors hold a more optimistic view that expanded uses (such as inviting patients to participate in EHR viewing during the clinical encounter) are untapped tools for patient activation. We share the optimism of White and Danis for health care information technology. During an era of technology innovation and adoption in all aspects of daily life, patients as well as medical professionals are, in general, becoming increasingly familiar with computer use during the clinical encounter. Current EHR systems, however, can be awkward to use, and there is a lack of standardized data structure for true integration of patient data across different EHR platforms. 3 These issues are technical and will likely be overcome through innovations in EHR technology, allowing expanded EHR use to further enhance patient care. Additionally, there is a growing repertoire of technologybased tools for patient activation that can complement the EHR. The relatively nascent web-based patient portals allow patients to securely log in and access their personal health information. The portal pulls data from the patient’s EHR and can support items such as screening reminders and patient-physician messaging. One study showed that patient portals in conjunction with an EHR may improve patient engagement. 4 Health care–focused social networks also offer a platform for patient activation. Patients can post questions online about their health condition. Physicians registered with the network can then post answers, which can be peer reviewed by other registered physicians. As medical students, we believe proper EHR usage instruction during medical education is important. Patientphysician communication is a part of the standard curriculum at most medical schools. For example, during our preclinical years, we learned a patient-centered model of patient interviewing. These interviews can serve as opportunities for students to practice using the EHR in a way to enhance the interaction. Appropriate use of the EHR to enhance patient activation can thus be taught concurrently with patient communication. 2,5 Ultimately, EHR education

Patient-Physician Interactions and Electronic Health Records

To the Editor In their recent Viewpoint, Drs White and Danis 1 discussed using the electronic health record (EHR) to enhance patient-physician interactions. Whereas others have argued that the EHR can hinder patient-physician communication, 2 the authors hold a more optimistic view that expanded uses (such as inviting patients to participate in EHR viewing during the clinical encounter) are untapped tools for patient activation. We share the optimism of White and Danis for health care information technology. During an era of technology innovation and adoption in all aspects of daily life, patients as well as medical professionals are, in general, becoming increasingly familiar with computer use during the clinical encounter. Current EHR systems, however, can be awkward to use, and there is a lack of standardized data structure for true integration of patient data across different EHR platforms. 3 These issues are technical and will likely be overcome through innovations in EHR technology, allowing expanded EHR use to further enhance patient care. Additionally, there is a growing repertoire of technologybased tools for patient activation that can complement the EHR. The relatively nascent web-based patient portals allow patients to securely log in and access their personal health information. The portal pulls data from the patient’s EHR and can support items such as screening reminders and patient-physician messaging. One study showed that patient portals in conjunction with an EHR may improve patient engagement. 4 Health care–focused social networks also offer a platform for patient activation. Patients can post questions online about their health condition. Physicians registered with the network can then post answers, which can be peer reviewed by other registered physicians. As medical students, we believe proper EHR usage instruction during medical education is important. Patientphysician communication is a part of the standard curriculum at most medical schools. For example, during our preclinical years, we learned a patient-centered model of patient interviewing. These interviews can serve as opportunities for students to practice using the EHR in a way to enhance the interaction. Appropriate use of the EHR to enhance patient activation can thus be taught concurrently with patient communication. 2,5 Ultimately, EHR education

Applications of electronic health information in public health: uses, opportunities & barriers.

Electronic health information systems can reshape the practice of public health including public health surveillance, disease and injury investigation and control, decision making, quality assurance, and policy development. While these opportunities are potentially transformative, and the federal program for the Meaningful Use (MU) of electronic health records (EHRs) has included important public health components, significant barriers remain. Unlike incentives in the clinical care system, scant funding is available to public health departments to develop the necessary information infrastructure and workforce capacity to capitalize on EHRs, personal health records, or Big Data. Current EHR systems are primarily built to serve clinical systems and practice rather than being structured for public health use. In addition, there are policy issues concerning how broadly the data can be used by public health officials. As these issues are resolved and workable solutions emerge, they should yield a more efficient and effective public health system.

Primary care practitioners' views on test result management in EHR-enabled health systems: a national survey

ContextFailure to notify patients of test results is common even when electronic health records (EHRs) are used to report results to practitioners. We sought to understand the broad range of social and technical factors that affect test result management in an integrated EHR-based health system.MethodsBetween June and November 2010, we conducted a cross-sectional, web-based survey of all primary care practitioners (PCPs) within the Department of Veterans Affairs nationwide. Survey development was guided by a socio-technical model describing multiple inter-related dimensions of EHR use.FindingsOf 5001 PCPs invited, 2590 (51.8%) responded. 55.5% believed that the EHRs did not have convenient features for notifying patients of test results. Over a third (37.9%) reported having staff support needed for notifying patients of test results. Many relied on the patient's next visit to notify them for normal (46.1%) and abnormal results (20.1%). Only 45.7% reported receiving adequate training on using the EHR notification system and 35.1% reported having an assigned contact for technical assistance with the EHR; most received help from colleagues (60.4%). A majority (85.6%) stayed after hours or came in on weekends to address notifications; less than a third reported receiving protected time (30.1%). PCPs strongly endorsed several new features to improve test result management, including better tracking and visualization of result notifications.ConclusionsDespite an advanced EHR, both social and technical challenges exist in ensuring notification of test results to practitioners and patients. Current EHR technology requires significant improvement in order to avoid similar challenges elsewhere.

Instant replay

With widespread adoption of electronic health records (EHRs) and electronic clinical documentation, health care organizations now have greater faculty to review clinical data and evaluate the efficacy of quality improvement efforts. Unfortunately, I believe there is a fundamental gap between actual health care delivery and what we document in the current EHR systems. This process of capturing the patient encounter, which I'll refer to as transcription, is prone to significant data loss due to inadequate methods of data capture, multiple points of view, and bias and subjectivity in the transcriptional process. Our current EHR, text-based clinical documentation systems are lossy abstractions − one sided accounts of what take place between patients and providers. Our clinical notes contain the breadcrumbs of relationships, conversations, physical exams, and procedures but often lack the ability to capture the form, the emotions, the images, the nonverbal communication, and the actual narrative of interactions between human beings. I believe that a video record, in conjunction with objective transcriptional services and other forms of data capture, may provide a closer approximation to the truth of health care delivery and may be a valuable tool for healthcare improvement.

APA to Survey Members About EHR Use

Back to table of contents Previous article Next article Professional NewsFull AccessAPA to Survey Members About EHR UseMark MoranMark MoranSearch for more papers by this authorPublished Online:4 Jan 2013https://doi.org/10.1176/appi.pn.2013.12b18AbstractThe survey should help inform the design of future electronic health record (EHR) systems for psychiatrists and minimize or avoid pitfalls associated with EHRs.Are you using an electronic health record (EHR), and if so what kind? APA wants to know and will be surveying its members early this year to find out.In conjunction with AmericanEHR Partners and the American College of Physicians (ACP), APA is participating in a nationwide survey of physicians from every major specialty group. The survey, which is being e-mailed to members this month, is designed to ascertain the extent to which physicians are using electronic health records, the kinds of products they use, and their opinions about them.Members who complete the survey will be entered into a drawing for a new Apple mini-tablet computer.Robert Plovnick, M.D., M.S., director of APA’s Office of Quality Improvement and Psychiatric Services, said the survey will take approximately 50 minutes to complete. It consists of a set of questions that every physician, regardless of specialty, will be asked; a second set of questions targeting those who are currently using some kind of EHR product; and a third set of questions specifically for psychiatrists.Responses to the survey will be confidential, and physician identities will not be used in reporting survey results.“The goal is to get a sense of EHR usage and collect detailed information on the products currently used by psychiatrists,” Plovnick told Psychiatric News. “This is directly responsive to requests we have received from all areas of the organization. Everyone wants to know which EHRs psychiatrists are using and what they think of them, so we can have a sense of the state of the EHR market and help our members make their own purchasing decisions.“So far we have had to rely on anecdotal evidence, so the survey is an opportunity to provide more-robust information about available EHR products to our members,” he said. “The more feedback we get, the more useful it will be to the field.”(According to its Web site, AmericanEHR Partners has been developed by Cientis Technologies and ACP; it provides physicians, state and federal agencies, vendors, and funding organizations with tools to identify, implement, and effectively use electronic health records and other health care technologies.)The psychiatry-specific questions gauge clinician satisfaction with the ability of an EHR to use DSM diagnoses and coding; ability to create or customize templates for psychiatry specific documentation; ability to manage separate psychotherapy notes; ability to create and share records with members of a treatment team, including other physicians, psychologists, and social workers; and ability to record substance use, among other issues.Psychiatrist Daniel Balog, M.D., a member of APA’s Committee on Electronic Health Records, said psychiatrist participation in the survey can also help influence the design of EHR products in the future.“The majority of current EHR systems were designed with a predominance of medical input, so APA’s involvement in this clinical survey provides member psychiatrists a platform to share their EHR experiences,” Balog told Psychiatric News. “The survey includes specialty questions designed by the APA EHR Committee to target information relevant to member psychiatrists who are shopping for EHR systems or who are in a position to influence purchasing decisions made by larger organizations.” ■More information about EHRs is posted on the APA Web site at http://www.psychiatry.org/ehr. Information about American EHR Partners, including information about EHR products derived from responses from physicians who have completed the survey, is posted at http://www.americanehr.com. ISSUES NewArchived

The Future of Cardiovascular Clinical Research

SUBSTANTIAL AGE-ADJUSTED REDUCTIONS IN CARDIOvascular mortality and morbidity over the past few decades are being challenged by increases in physical inactivity, diabetes mellitus, and obesity, creating a large and aging population with long-term cardiovascular disease (CVD). However, the US national investments in discovery and translational science continue to produce major advances, both in understanding these conditions at the cellular level and in development of therapeutic and diagnostic tools that can improve health outcomes. Innovative research and clinical opportunities may arise from the ability to combine clinical and geospatial data at the regional scale in large, integrated health care delivery systems. The concept of a “learning health system” can be advanced if this capacity is coupled with the ability to perform practical clinical trials and comparative effectiveness research, using the results to further improve health and health care. Such integrated systems promise a common approach to issues that previously seemed irreconcilable: personalized medicine vs population health, traditional medicine vs public health. The CVD epidemic is particularly amenable to this approach because of its magnitude, the advanced understanding of its biological and social basis, and the availability of effective treatments. Reductions in cardiovascular morbidity and mortality, however, will depend on enhanced individual and community engagement with the research enterprise. The advent of electronic health records (EHRs) in the 1970s created expectations, but the challenges of human interfaces in these early systems, coupled with a lack of terminology standards and limited computational power for large data sets, restricted electronic data capture to specialized applications: simply collecting data in one place was a major task. After 3 decades of technological progress, population clinical data sets for research are more widely available, and the major challenges are (1) organizing data into information, (2) analyzing information to distill actionable knowledge, and (3) presenting knowledge in ways that can inform personal or policy decisions. Debate continues about how current EHR user interfaces help or hinder patient outcomes. However, the overall efficiency of medicine and the rational basis for decision making will be enhanced as the practical issues of integrating data, information, and knowledge into clinical care and public health practice are solved. Two projects provide examples of the potential of this approach. These efforts integrate clinical and geospatially mapped data with the purpose of improving individual and population health in geographically defined regions, accelerating the rate at which reliable evidence can be generated to support rational decision making. This work is predicated on informatics-driven approaches to the disciplined collection of structured data as part of routine clinical practice and to aggregating those data in novel ways that enable multiple uses. The first project is based in Durham County, North Carolina, and uses geospatial methods to connect clinical data from Duke Medicine, the Durham County Health Department, and Lincoln Community Health Center (Durham’s Federally Qualified Health Center) with data on housing, neighborhoods, social stressors, environmental exposures, and culture. This allows researchers and clinicians to understand patients both from their medical records and from the social and environmental contexts in which they live, work, and play. This project also has engaged the Durham community in a direct conversation about how the composite influences of human biology and social and environmental influences shape individual and population health, as well as how this knowledge can and should be used to develop tailored, community-based interventions that improve individual and population health. The second project builds on this approach but focuses particularly on adults living with type 2 diabetes mellitus and extends the work to other counties in North Carolina, Mississippi, and West Virginia.