A partnership model for implementing electronic health records in resource-limited primary care settings: experiences from two nurse-managed health centers
- Patricia Dennehy1,2,
- Mary P White3,4,
- Andrew Hamilton5,
- Joanne M Pohl6,7,
- Clare Tanner7,8,
- Tiffiani J Onifade8,
- Kai Zheng9,10
- 1Glide Health Services, San Francisco, California, USA
- 2Department of Community Health Systems, University of California San Francisco, San Francisco, California, USA
- 3Campus Health Center, Wayne State University, Detroit, Michigan, USA
- 4College of Nursing, Wayne State University, Detroit, Michigan, USA
- 5Alliance of Chicago Community Health Services, Chicago, Illinois, USA
- 6School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
- 7Institute for Nursing Centers, Michigan Public Health Institute, Okemos, Michigan, USA
- 8Center for Data Management and Translational Research, Michigan Public Health Institute, Okemos, Michigan, USA
- 9School of Public Health Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan, USA
- 10School of Information, University of Michigan, Ann Arbor, Michigan, USA
- Correspondence to Kai Zheng, School of Public Health Department of Health Management and Policy, University of Michigan, M3531 SPH II, 109 South Observatory Street, Ann Arbor, MI 48109-2029, USA;
- Received 15 January 2011
- Accepted 31 May 2011
- Published Online First 9 August 2011
Objective To present a partnership-based and community-oriented approach designed to ease provider anxiety and facilitate the implementation of electronic health records (EHR) in resource-limited primary care settings.
Materials and Methods The approach, referred to as partnership model, was developed and iteratively refined through the research team's previous work on implementing health information technology (HIT) in over 30 safety net practices. This paper uses two case studies to illustrate how the model was applied to help two nurse-managed health centers (NMHC), a particularly vulnerable primary care setting, implement EHR and get prepared to meet the meaningful use criteria.
Results The strong focus of the model on continuous quality improvement led to eventual implementation success at both sites, despite difficulties encountered during the initial stages of the project.
Discussion There has been a lack of research, particularly in resource-limited primary care settings, on strategies for abating provider anxiety and preparing them to manage complex changes associated with EHR uptake. The partnership model described in this paper may provide useful insights into the work shepherded by HIT regional extension centers dedicated to supporting resource-limited communities disproportionally affected by EHR adoption barriers.
Conclusion NMHC, similar to other primary care settings, are often poorly resourced, understaffed, and lack the necessary expertise to deploy EHR and integrate its use into their day-to-day practice. This study demonstrates that implementation of EHR, a prerequisite to meaningful use, can be successfully achieved in this setting, and partnership efforts extending far beyond the initial software deployment stage may be the key.
- Collaborative technologies
- community health care
- developing/using clinical decision support (other than diagnostic) and guideline systems
- electronic health records (E05.318.308.940.968.625.500)
- health information technology for economic and clinical health act (N03.706.615.049)
- human–computer interaction and human-centered computing
- improving healthcare workflow and process efficiency
- nurse-managed health centers
- personal health records and self-care systems
- qualitative/ethnographic field study
- regional extension centers
- social/organizational study
- system implementation and management issues
- systems supporting patient–provider interaction
Funding This work is supported by grant no 1R18HS017191 received from the Agency for Healthcare Research and Quality (PI: JMP), and in part by funding received from the W.K. Kellogg Foundation.
Competing interests None.
Ethics approval The research protocol of this study was reviewed and approved by the Medical School Institutional Review Board at the University of Michigan (IRB no HUM00015728) and the research ethics governing bodies at the respective study sites.
Provenance and peer review Not commissioned; externally peer reviewed.