Centers speak up: the clinical context for health information technology in the ambulatory care setting.
BACKGROUND
Clinicians in ambulatory care settings are increasingly called upon to use health information technology (health IT) to improve practice efficiency and performance. Successful adoption of health IT requires an understanding of how clinical tasks and workflows will be affected; yet this has not been well described.


OBJECTIVE
To describe how health IT functions within a clinical context.


METHODS
Qualitative study, using in-depth, semi-structured interviews.


METHODS
Executives and staff at 4 community health centers, 3 health center networks, and 1 large primary care organization.


METHODS
Transcribed audio-recorded interviews, analyzed using the constant comparative method.


RESULTS
Systematic characterization of clinical context identified 6 primary clinical domains. These included results management, intra-clinic communication, patient education and outreach, inter-clinic coordination, medication management, and provider education and feedback. We generated clinical process diagrams to characterize these domains. Participants suggested that underlying workflows for these domains must be fully operational to ensure successful deployment of health IT.


CONCLUSIONS
Understanding the clinical context is a necessary precursor to successful deployment of health IT. Process diagrams can serve as the basis for EHR certification, to identify challenges, to measure health IT adoption, or to develop curricular content regarding the role of health IT in clinical practice.
Leu
Michael G
MG
Children's Hospital and Regional Medical Center, Seattle, WA 98105, USA. michael.leu@seattlechildrens.org
Cheung
Ming
M
Webster
Tashonna R
TR
Curry
Leslie
L
Bradley
Elizabeth H
EH
Fifield
Judith
J
Burstin
Helen
H
D000288:Administrative Personnel; D000555:Ambulatory Care Information Systems; D020811:Biomedical Technology / Q000379:methods*; D003151:Community Health Centers / Q000458:organization & administration*; D004059:Diffusion of Innovation; D006801:Humans; D007407:Interviews as Topic; D050316:Medical Order Entry Systems; D016347:Medical Records Systems, Computerized; D010818:Practice Patterns, Physicians'; D014481:United States