Centers speak up: the clinical context for health information technology in the ambulatory care setting.

Abstract

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. DESIGN: Qualitative study, using in-depth, semi-structured interviews. PARTICIPANTS: Executives and staff at 4 community health centers, 3 health center networks, and 1 large primary care organization. APPROACH: 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.