Electronic medical record implementation for a healthcare system caring for homeless people.

EMR implementation community health centers electronic medical records homeless medical informatics

Journal

JAMIA open
ISSN: 2574-2531
Titre abrégé: JAMIA Open
Pays: United States
ID NLM: 101730643

Informations de publication

Date de publication:
Apr 2019
Historique:
received: 25 04 2018
revised: 20 09 2018
accepted: 22 10 2018
entrez: 28 1 2020
pubmed: 16 11 2018
medline: 16 11 2018
Statut: epublish

Résumé

Electronic medical record (EMR) implementation at centers caring for homeless people is constrained by limited resources and the increased disease burden of the patient population. Few informatics articles address this issue. This report describes Boston Health Care for the Homeless Program's migration to new EMR software without loss of unique care elements and processes. Workflows for clinical and operational functions were analyzed and modeled, focusing particularly on resource constraints and comorbidities. Workflows were optimized, standardized, and validated before go-live by user groups who provided design input. Software tools were configured to support optimized workflows. Customization was minimal. Training used the optimized configuration in a live training environment allowing users to learn and use the software before go-live. Implementation was rapidly accomplished over 6 months. Productivity was reduced at most minimally over the initial 3 months. During the first full year, quality indicator levels were maintained. Keys to success were completing before go-live workflow analysis, workflow mapping, building of documentation templates, creation of screen shot guides, role-based phased training, and standardization of processes. Change management strategies were valuable. The early availability of a configured training environment was essential. With this methodology, the software tools were chosen and workflows optimized that addressed the challenges unique to caring for homeless people. Successful implementation of an EMR to care for homeless people was achieved through detailed workflow analysis, optimizing and standardizing workflows, configuring software, and initiating training all well before go-live. This approach was particularly suitable for a homeless population.

Identifiants

DOI: 10.1093/jamiaopen/ooy046 PMID: 31984348 PMC: PMC6951900
pubmed: 31984348
doi: 10.1093/jamiaopen/ooy046
pii: ooy046
pmc: PMC6951900
doi:

Types de publication

Journal Article

Langues

eng

Pagination

89-98

Informations de copyright

© The Author(s) 2018. Published by Oxford University Press on behalf of the American Medical Informatics Association.

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Auteurs

Gerald H Angoff (GH)

Department of Pediatrics Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA.

James J O'Connell (JJ)

Department of Primary Care Medicine Massachusetts General Hospital, Harvard Medical School, Boston Health Care for the Homeless Program, Boston, Massachusetts, USA.

Jessie M Gaeta (JM)

Department of General Internal Medicine Boston Medical Center, Boston University School of Medicine, Boston Health Care for the Homeless Program, Boston, Massachusetts, USA.

Denise De Las Nueces (D)

Department of General Internal Medicine Boston Medical Center, Boston Health Care for the Homeless Program, Boston, Massachusetts, USA.

Michael Lawrence (M)

Boston Health Care for the Homeless Program, Boston, Massachusetts, USA.

Sanju Nembang (S)

Boston Health Care for the Homeless Program, Boston, Massachusetts, USA.

Travis P Baggett (TP)

Department of Primary Care Medicine Massachusetts General Hospital, Harvard Medical School, Boston Healthcare for the Homeless Program, Boston, Massachusetts, USA.

Classifications MeSH