title: Implementation and use of an electronic health record within the Indian Health Service.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA 02120, USA. tsequist@partners.org
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Sequist
authors.forename: Theresa
authors.initials: T
authors.lastname: Cullen
authors.forename: Howard
authors.initials: H
authors.lastname: Hays
authors.forename: Maile M
authors.initials: MM
authors.lastname: Taualii
authors.forename: Steven R
authors.initials: SR
authors.lastname: Simon
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
mesh_terms: D001291:Attitude of Health Personnel; D001292:Attitude to Computers; D003625:Data Collection; D006284:Health Plan Implementation; D006801:Humans; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data; D008507:Medically Underserved Area; D009936:Organizational Innovation; D010821:Physicians, Family; D011787:Quality of Health Care; D019035:Rural Health Services / Q000458:organization & administration; D014481:United States; D016549:United States Indian Health Service / Q000458:organization & administration*