Perceived efficiency impacts following electronic health record implementation: an exploratory study of an urban community health center network

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This article was published in International Journal of Medical Informatics in 2010 and addresses the impact of EHR implementation on perceived efficiency in community health center (CHC) environment. [1]


Quality and efficiency benefits of an EHR may be particularly important for resource-constrained organizations such as community health centers (CHC). This study attempted to identify opportunities and challenges associated with EHR implementation in a large, urban, multi-site CHC environment.


The authors conducted qualitative research and involved multiple key informant interviews. Key informants included physicians, clinical staff and administrators. Data were collected through site visits and calls at three CHC sites and the CHC network headquarters located in the same U.S. city. The focus of the research was:

1) The perceived impacts of EHR implementation on clinical workflow and perceptions of care delivery.

2) Barriers and challenges associated with the implementation process as seen by EHR users.


The authors were able to separate two major sub-themes within the data: improvements in workflow efficiencies and laboratory turn-around efficiencies. Many informants also pointed out that EHR implementation resulted in extra work such as: new work resulting with the introduction of the EHR, work to address EHR-related errors, and creation of workarounds to address limitations of the EHR. Challenges that impacted perceptions of CHC efficiency included resource constraints, CHC-specific challenges (serving unique population categories such as homeless, HIV-positive, transgender), and EHR interface challenges.


EHR implementation can have both positive and negative impact on efficiency in CHC organizations. The communities served by CHC can greatly benefit even from small quality improvement gains. The well-supported and comprehensive EHR implementation can help these resource-constrained organizations to achieve such gains.


The results of the study has can have broader applicability as many healthcare organizations face the same challenges with EHR implementation, such as resource constraints or user interface problem.

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  1. Ann Scheck McAlearney, Julie Robbins, Annemarie Hirsch, Maria Jorina, J. Phil Harrop. Perceived efficiency impacts following electronic health record implementation: An exploratory study of an urban community health center network.