Requirements First: An EHR Recommendation for Free Clinics.

摘要

UC Davis (UCD) School of Medicine is affiliated with and supports (with student volunteers, lab services and some limited pharmacy and other services) seven student-run free clinics in Sacramento, each focused on one or more underserved population. Although the UC Davis Health System uses a comprehensive EPIC application for their EHR solution, the clinics are independent and rely almost entirely on paper records.;The student-run free clinics provide an excellent local case study, perhaps a sandbox, for developing an exportable EHR adoption model in order to provide the benefits of an EHR to an underserved population at these and other small clinics. The free clinic example can be used to architect an EHR solution for similar small clinics and rural clinics that face similar obstacles to EHR implementation---limited funding, limited resources, volunteer staff, limited hour of operations, limited services, often limited facilities and infrastructure. The purpose of this study is to document the EHR business and technical requirements of the seven UCD student-run free clinics and to develop a strategy for successfully implementing an EHR at the clinics.;Previous efforts to implement an EHR in comparable clinic environments provide insights into the particular challenges faced by small clinics, such as financial constraints, limited if any access to technical specialists, governance/control agency restrictions, lack of available IT resources for implementation or on-going maintenance. Many previous efforts began with an existing operational framework and fit the clinics into that solution. Those implementations were a success and continue in use, but are not portable as they are dependent on local external resources and organizations. None of them devoted much time to gathering clinic business requirements, choosing rather to implement a solution that "was available.";The methodology followed in this study was to use my own eyes (and ears) to leverage years of IT requirements gathering experience and more recently the lessons of the Health Informatics Program course work in order to uncover the business and clinical requirements and workflow that should drive evaluation of available EHR functionality. The field research is based on personal on-site assessment of each clinic and face-to-face interviews with critical stakeholders.;My research focused on clinic-specific EHR requirements. However, my findings need context and I used the CCHIT Ambulatory EHR requirements as an initial baseline of requirements. The CCHIT requirements represent the minimum requirements for Ambulatory EHR certification. The Student-Run Free Clinics have additional specific needs beyond the CCHIT EHR baseline such as for handling pharmacy information and patient scheduling.;The free clinics need a system that all can adopt, that is easy to use within a properly secured environment. Implementation and on-going support requirements must be minimal due to limited budgets and frequent staff turnover. The various requirements for each unique clinic are herein synthesized and articulated using quality standards to ensure that a single system can meet those needs.;There are common business and technical requirements that can be achieved with the proper selection of a proven Electronic Health Record application. An implementation strategy is proposed that considers clinic governance and the nature and availability of resources available to support the implementation. A web-based (minimum infrastructure), CCHIT EHR compliant (to ensure basic functionality) solution chosen by all clinics will support improved patient care and attainment of individual clinic goals.