Community Health Centers
Implementing EHRs:
Lessons Learned
Oliver Droppers, M.P.H., Sherril Gelmon, Dr.P.H.,
Siobhan Maty, Ph.D., and Vickie Gates
Portland State University
Session Overview
ƒ Framing the issue
ƒ Research objective
ƒ Study design and population
ƒ Principal findings
ƒ Conclusions
ƒ Implications
Framing the Issue
ƒ Unique missions and challenging patient populations
of safety net clinics
Potential of EHRs in CHCs
ƒ Enhance coordination and integration of services
ƒ Considerable resource constraints
ƒ Increase service efficiency
ƒ Turbulent and unstable environment
ƒ Improve quality of health care services
ƒ Electronic Health Records (EHR) in community
health centers (CHC) are new trend
ƒ EHR longlong-term viability/sustainability uncertain
ƒ Improve population health management
ƒ Establish comprehensive data repositories for
assessment, reporting and research purposes
Research Objectives
Study Design
ƒ To investigate and improve understanding of
ƒ Identify existing models/methods for evaluation and
unique and complex organizational barriers
and challenges to EHR adoption in CHCs
ƒ To identify key factors, challenges and
promising practices for successful EHR
implementation in CHCs
application
ƒ Build knowledge among evaluation team
ƒ Create evaluation framework based upon best or
promising practices
ƒ Develop communitycommunity-responsive collaborative data
collection strategies and dissemination methods
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Population Studied
ƒ Two federally qualified communitycommunity-based
health centers operated by a county health
department
ƒ Each center employs 4040-50 fullfull-time staff
members
ƒ Centers serve medically uninsured and
underserved populations in Portland, OR
Principal Findings: Challenges
ƒ Significant impact on staff and providers
ƒ Use of EHR among certain provider groups
“problematic”
problematic”
ƒ ProviderProvider-patient interaction changes
ƒ Need adequate provision of ongoing and continuous
training and IT support
ƒ Regular modifications required to respond to specific
needs and patient populations at CHCs
Principal Findings: Benefits
ƒ Improved quality of patient care
ƒ Increased ease in accessibility and reliability of
patients’
patients’ medical records
ƒ Improved legibility, decreased errors
ƒ Improved processes for internal
communications, patient followfollow-up, tracking
events, patient referrals, ordering and
accessibility of lab results
ƒ Overall EHR has been a positive change for
patients, staff and providers
Implications for CHCs
ƒ EHRs can potentially improve overall quality of care
provided by CHCs
ƒ EHRs are a complex, multifunctional, and challenging
technology for any CHC
Conclusions:
Organizational Success Factors
ƒ Strong organizational infrastructure
ƒ Committed administrative and clinical leadership
ƒ Existence of clear strategic implementation plan
ƒ Carefully redesigned organizational processes and workflows
ƒ Comprehensive training of staff prior to, during, and after
implementation
ƒ Adequate endend-user IT support
ƒ Ability to respond and adapt rapidly to barriers/changes
For Further Information
ƒ Oliver Droppers, Graduate Research Assistant,
Portland State University, odropper@pdx.
odropper@pdx.edu
ƒ Sherril Gelmon, Professor of Public Health, Portland
State University,
University, gelmons@pdx.edu
ƒ Successful adoption of EHRs in the safety net context
requires:
• Strong organizational infrastructure and
commitment
• Significant capacity for effective change
management and ongoing learning
• Adequate human and technological resources
Supported by the Kaiser Community Fund and the
Northwest Health Foundation
Our thanks to the staff of the
North Portland and MidMid-County Health Centers,
Multnomah County Health Department
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