title: Approaches and challenges to optimising primary care teams' electronic health record usage.
abstract: BACKGROUND
  Although the presence of an electronic health record (EHR) alone does not ensure high quality, efficient care, few studies have focused on the work of those charged with optimising use of existing EHR functionality.
  
  
  OBJECTIVE
  To examine the approaches used and challenges perceived by analysts supporting the optimisation of primary care teams' EHR use at a large U.S. academic health care system.
  
  
  METHODS
  A qualitative study was conducted. Optimisation analysts and their supervisor were interviewed and data were analysed for themes.
  
  
  RESULTS
  Analysts needed to reconcile the tension created by organisational mandates focused on the standardisation of EHR processes with the primary care teams' demand for EHR customisation. They gained an understanding of health information technology (HIT) leadership's and primary care team's goals through attending meetings, reading meeting minutes and visiting with clinical teams. Within what was organisationally possible, EHR education could then be tailored to fit team needs. Major challenges were related to organisational attempts to standardise EHR use despite varied clinic contexts, personnel readiness and technical issues with the EHR platform. Forcing standardisation upon clinical needs that current EHR functionality could not satisfy was difficult.
  
  
  CONCLUSIONS
  Dedicated optimisation analysts can add value to health systems through playing a mediating role between HIT leadership and care teams. Our findings imply that EHR optimisation should be performed with an in-depth understanding of the workflow, cognitive and interactional activities in primary care.
authors.affiliation: UW Health, Primary Care Academics Transforming Healthcare, 800 University Bay Drive, Madison, WI 53705, USA; University of Wisconsin School of Medicine and Public Health, Department of Family Medicine, 1100 Delaplaine Court, Madison, WI 53715, USA; UW Health, Primary Care Academics Transforming Healthcare, 800 University Bay Drive, Box 9445 Madison, WI 53705, USA. nancy.pandhi@fammed.wisc.edu.
authors.forename: Nancy
authors.initials: N
authors.lastname: Pandhi
authors.affiliation: National Cheng Kung University, Center of Teacher Education, 1 Ta-Hsueh Road Tainan City, Taiwan, ROC; National Cheng Kung University, Institute of Education, No. 1, University Road, Tainan City, Taiwan, ROC.
authors.forename: Wan-Lin
authors.initials: WL
authors.lastname: Yang
authors.affiliation: UW Health, Primary care Academics Transforming Healthcare, 800 University Bay Drive, Madison, WI 53705, USA; University of Wisconsin School of Medicine and Public Health, Department of Family Medicine, 1100 Delaplaine Court, Madison, WI 53715, USA; University of Wisconsin School of Medicine and Public Health, Department of Population Health Sciences, 610 North Walnut Street, Madison, WI 53726, USA.
authors.forename: Zaher
authors.initials: Z
authors.lastname: Karp
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Department of Family Medicine, 1100 Delaplaine Court, Madison, WI 53715, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Young
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Department of Family Medicine, 1100 Delaplaine Court, Madison, WI 53715, USA; University of Wisconsin, Department of Industrial and Systems Engineering, 1415 Engineering Drive, Madison, WI 53706, USA.
authors.forename: John W
authors.initials: JW
authors.lastname: Beasley
authors.affiliation: UW Health, Primary care Academics Transforming Healthcare, 800 University Bay Drive, Madison, WI 53705, USA; University of Wisconsin School of Medicine and Public Health, Department of Medicine, 750 Highland Avenue, Madison, WI 53705, USA; Quality, Safety and Innovation, UW Health, 7974 UW Health Court, Middleton, WI 53562, USA.
authors.forename: Sally
authors.initials: S
authors.lastname: Kraft
authors.affiliation: University of Wisconsin, Department of Industrial and Systems Engineering, 1415 Engineering Drive, Madison, WI 53706, USA; University of Wisconsin, Center for Quality and Productivity Improvement, 1415 Engineering Drive, Madison, WI 53706, USA.
authors.forename: Pascale
authors.initials: P
authors.lastname: Carayon
mesh_terms: D057286:Electronic Health Records / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D007407:Interviews as Topic; D007857:Leadership; D010348:Patient Care Team; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research; D014481:United States