title: Using the diffusion of innovations theory to assess socio-technical factors in planning the implementation of an electronic health record alert across multiple primary care clinics.
abstract: Adverse drug events (ADEs) are a leading cause of death in the United States. Patients with stage 3 and 4 chronic kidney disease (CKD) are at particular risk because many medications are cleared by the kidneys. Alerts in the electronic health record (EHR) about drug appropriateness and dosing at the time of prescription have been shown to reduce ADEs for patients with stage 3 and 4 CKD in inpatient settings, but more research is needed about the implementation and effectiveness of such alerts in outpatient settings.
  
  
  
  To explore factors that might inform the implementation of an electronic drug-disease alert for patients with CKD in primary care clinics, using Rogers' diffusion of innovations theory as an analytic framework.
  
  
  
  Interviews were conducted with key informants in four diverse clinics using various EHR systems. Interviews were audio recorded and transcribed. results Although all clinics had a current method for calculating glomerular filtration rate (GFR), clinics were heterogeneous with regard to current electronic decision support practices, quality improvement resources, and organizational culture and structure.
  
  
  
  Understanding variation in organizational culture and infrastructure across primary care clinics is important in planning implementation of an intervention to reduce ADEs among patients with CKD.
authors.affiliation: Institute of Translational Health Sciences, University of Washington, Seattle, Washington, USA. ping@uw.edu.
authors.forename: Ching-Pin
authors.initials: CP
authors.lastname: Lin
authors.affiliation: Institute of Translational Health Sciences, University of Washington, Seattle, Washington, USA. janelle.guirguis-blake@multicare.org.
authors.forename: Janelle
authors.initials: J
authors.lastname: Guirguis-Blake
authors.affiliation: Department of Family Medicine, University of Washington, Seattle, Washington, USA. gakeppel@uw.edu.
authors.forename: Gina A
authors.initials: GA
authors.lastname: Keppel
authors.affiliation: Department of Family Medicine, University of Washington, Seattle, Washington, USA. dob@uw.edu.
authors.forename: Sharon
authors.initials: S
authors.lastname: Dobie
authors.affiliation: Department of Family Medicine, University of Washington, Seattle, Washington, USA. josborn@uw.edu.
authors.forename: Justin
authors.initials: J
authors.lastname: Osborn
authors.affiliation: Department of Family Medicine, University of Washington, Seattle, Washington, USA. acole2@uw.edu.
authors.forename: Allison M
authors.initials: AM
authors.lastname: Cole
authors.affiliation: Department of Family Medicine, University of Washington, Seattle, Washington, USA. lmb@uw.edu.
authors.forename: Laura-Mae
authors.initials: LM
authors.lastname: Baldwin
mesh_terms: D000554:Ambulatory Care Facilities; D004059:Diffusion of Innovation; D064420:Drug-Related Side Effects and Adverse Reactions; D057286:Electronic Health Records; D006801:Humans; D011320:Primary Health Care
keywords: adverse drug event; chronic kidney diseases; electronic health records; medication alert systems; outpatient clinic; primary care