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J Am Med Inform Assoc 2007;14:191-197 doi:10.1197/jamia.M2234
  • Research paper
    • Original Investigation

Implementation and Use of an Electronic Health Record within the Indian Health Service

  1. Thomas D Sequista,b,
  2. Theresa Cullene,
  3. Howard Hayse,
  4. Maile M Taualiif,
  5. Steven R Simonc,d,
  6. David W Batesa
  1. aDivision of General Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA
  2. bDepartment of Health Care Policy, Harvard Medical School, Boston, MA
  3. cDepartment of Ambulatory Care and Prevention, Harvard Medical School, Boston, MA
  4. dHarvard Pilgrim Health Care, Boston, MA
  5. eIndian Health Service Office of Information Technology, Phoenix, AZ
  6. fSeattle Indian Health Board, Seattle, WA
  1. Correspondence and reprints: Thomas D. Sequist, MD, MPH, BWH Division of General Medicine, 1620 Tremont Street, Boston, MA 02120. (Email: tsequist{at}partners.org)
  • Received 31 July 2006
  • Accepted 11 December 2006

Abstract

Objectives There are limited data regarding implementing electronic health records (EHR) in underserved settings. We evaluated the implementation of an EHR within the Indian Health Service (IHS), a federally funded health system for Native Americans.

Design We surveyed 223 primary care clinicians practicing at 26 IHS health centers that implemented an EHR between 2003 and 2005.

Methods The survey instrument assessed clinician attitudes regarding EHR implementation, current utilization of individual EHR functions, and attitudes regarding the use of information technology to improve quality of care in underserved settings. We fit a multivariable logistic regression model to identify correlates of increased utilization of the EHR.

Results The overall response rate was 56%. Of responding clinicians, 66% felt that the EHR implementation process was positive. One-third (35%) believed that the EHR improved overall quality of care, with many (39%) feeling that it decreased the quality of the patient–doctor interaction. One-third of clinicians (34%) reported consistent use of electronic reminders, and self-report that EHRs improve quality was strongly associated with increased utilization of the EHR (odds ratio 3.03, 95% confidence interval 1.05–8.8). The majority (87%) of clinicians felt that information technology could potentially improve quality of care in rural and underserved settings through the use of tools such as online information sources, telemedicine programs, and electronic health records.

Conclusions Clinicians support the use of information technology to improve quality in underserved settings, but many felt that it was not currently fulfilling its potential in the IHS, potentially due to limited use of key functions within the EHR.

Footnotes

  • This study was partially funded by a contract to the Indian Health Service from the Agency for Healthcare Research and Quality. The authors would like to thank Eric Poon, MD, MPH, for his thoughtful critique of the survey instrument.

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