Implementation and use of an electronic health record within the Indian Health Service

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Sequest TD, Cullen T, Hayes H, Taualii MM, Simon SR, Bates DW. Implementation and use of an electronic health record within the Indian Health Service. J AM Med Inform Assoc. 2007 Mar-Apr;14(2):191-7

Introduction. This article aims to evaluate the implementation of an EHR in a rural underserved population. The study outlines the implementation of an EHR in 26 clinics of the Indian Health Service. They introduce the idea of improving the care of this population but never actually study the EHR effects but rather rely on the self reported feelings of the participating practitioners.

Methods. A survey was sent to all 223 primary care clinicians at 26 health centers. 125 Clinicians responded(56%). This was a post installation survey and the average time of use before the survey was 1.5 years. The survey evaluated Reported Use of Key EHR Functionality, Clinician Perception of Electronic Health Record Implementation and Utility of Information, and Perceived Barriers to Effective Implementation.

The study found that a high percentage of the respondents felt that the system implementation went well and supported the system only a third actually felt that the system helped improve care. This may be due to the fact that most sites had been using the system only 1-2 years and that clinical reminders were not turned on until 1 year after installation at most sites.

Conclusions. The last paragraph of the discussion gives several limitations of the study, the unique nature of the Indian Health Service, the “early adopter” status of the clinics, no usability testing was done, no information on the actual impact on quality was done. The authors encourage future work on clinician attitudes about the system and tha actual impact of the system on quality of care.