BACKGROUND: With the introduction of the Health Information Technology for Economic and Clinical Health (HITECH) act, local health departments (LHDs) have reported adopting electronic health records (EHRs) at a growing rate. However, these measures fail to capture the completeness of EHR adoption nor the maturity of an LHD's data management practices. The Orange County Health Department (OCHD) staff developed a collaborative, cross-departmental strategy to assess the status of their current EHR usage and optimize their EHR system department-wide.
METHODS: Four years after adopting an EHR system, OCHD staff identified several data quality issues, prompting the development of a plan to improve EHR use and standardize data practices. This proposal included, 1) the creation of an EHR optimization team comprised of department directors with decision-making authority that would 2) develop a strategic plan for EHR system optimization, 3) hire a temporary informatics intern to develop a standardized training manual for the EHR system, and 4) put together a team of EHR "superusers" (program managers) to flesh out program-specific needs.
RESULTS: The resulting EHR Optimization Team is comprised of 4 department managers and 3 informatics staff. This team meets bimonthly to investigate data issues, prioritize improvement projects, and brainstorm action steps towards achieving strategic goals. The optimization team has agreed upon a set of 4 primary goals and uses a work breakdown structure to guide ongoing efforts. Key informant interviews, observational research, time studies and swim lane diagrams were utilized by the informatics intern to develop a standardized training manual and curriculum. Initial progress measures are in development for 10 clinic programs. These measures will track change in data quality and patient outcomes over the course of strategic plan implementation. They will also be mapped to meaningful use requirements and program-specific goals for service improvements.
CONCLUSIONS: Variation in EHR use can cause serious challenges for LHDs. These issues are the product of EHR complexity, interface designs that are not conducive to existing clinic workflows, and duplication of efforts due to interoperability between the EHR system and state surveillance systems. At OCHD, challenges arose from implementing a single system across programs with differing needs and management direction. In this example, key informant interviews paired with a team of cross-departmental leaders with decision making power and a dedicated staff person with time to concentrate solely on EHR system use, was a successful strategy for identifying and addressing staff workarounds that had negatively impacted data quality and reporting.