Electronic Health Record Deployment Techniques

S. A. Kushinka of Full Circle Projects

These four issues briefs are tactically oriented and draw from experiences of real community clinics as they adopt electronic health records. The four topics are chart abstraction, clinical documentation, training strategies, and workflow.

January 2011

Starting in 2006, the California Networks for Electronic Health Record Adoption (CNEA) initiative has worked to speed adoption and lower the cost of electronic health records (EHRs) in California's community clinics and health centers. In August 2008, seven grantees representing four models of EHR deployment were funded to accelerate the adoption of EHRs in the safety net. In 2010, CHCF began publishing a series of tactically oriented issue briefs that highlight lessons learned since the initiative began.

The first issue brief in the series, Chart Abstraction: EHR Deployment Techniques, examines the process of entering or "populating" the electronic chart with clinical data from the paper record. This process entails an inevitable decrease in productivity due to disruption in workflow, user training, and the need to maintain both paper and electronic records during the transition period. Through clinical committees or other consensus building forums, CNEA grantees developed strategies that defined what information would be entered, when, and by whom — weighing the value of the information versus the cost of entering it. The clinics' experiences with these techniques and a discussion of pros and cons are included.

The issue brief Clinical Documentation: EHR Deployment Techniques describes the clinical documentation options available to users of most EHR systems. With EHRs, chart information can be accurately shared among multiple users, including specialists, behavioral care providers, labs and pharmacies, insurers, public health entities, and research organizations. This brief describes the various structured and free-form documentation methods, along with their advantages and disadvantages and the impact on efficiency and effectiveness of EHR use.

The third issue brief in the series, Training Strategies: EHR Deployment Techniques, explores three approaches to EHR training, their advantages and disadvantages, and the ways they can streamline workflow and standardize policies and procedures. The extensive training that is required to teach staff and providers to use an EHR system is one of the larger costs of implementation and an important opportunity for realizing the transformation in care delivery that EHRs can bring. Some of the grantee clinics' experiences with these techniques are discussed, along with insights that may be useful to other clinics implementing EHRs.

The fourth and final issue brief in the series, Workflow Analysis: EHR Deployment Techniques, explores the stages of workflow analysis, process mapping, and process redesign. By documenting and mapping all back office, front office, IT, and provider processes, the clinic team can identify the waste and bottlenecks embedded in its system. This current workflow is then used as a foundation for envisioning an improved workflow facilitated by the EHR. The issue brief uses examples from the CNEA grantees to illustrate the value of these tasks and how to approach them.

The issue briefs are available as Document Downloads.

Reader Comments

There are so many EHR options available right now, it was almost overwhelming to decide on one. After lots of research, we took a leap of faith with our provider and it has worked out pretty well. Make sure that the EHR you pick is specifically-tailored to your specialty, otherwise the workflow may not be ideal. For instance, our practice is a private-practice Ophthalmology clinic and we decided to go for a Ophtalmic-specific EHR software. If you are an Ophthalmologist or Optometrist - look into FoxFire EHR, it has worked well for us and their training far-surpassed that of other companies that we looked into.

The primary purpose of electronic health records adoption should be to make a medical practice more efficient by reducing the costs and the time it takes to perform a specific task. While the current breed of EHRs does help achieving the objectives, EHR adoption has been derived by the incentives that Government is providing for 'meaningful users' of EHR. I look forward to a day when the healthcare community realizes the importance of health records software and embraces EHR without the carrot of financial incentives offered by the Government.

I love that electronic health records are starting to be not only more recognizable but a more widely used technology. I agree with Greg if used right they can be a huge asset to patients, to save invaluable time and help people get better faster! Here is to hoping we can use it well!

Electronic health records are part of an interesting field. There's been some controversy around having medical records online where they could be "easily found" by anyone. But I really don't think that it is that easy. If proper precautions are taken, I think EHR is a great idea. But it is interesting - it takes 4 briefs, an entire series, to cover EHR? It must be some complex stuff (unless the briefs aren't as large as I'm imagining them - they are "briefs", should be short)