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Electronic Health Record Deployment Techniques

S. A. Kushinka of Full Circle Projects

These four issue 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.

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.