Design and Implementation of Electronic Health Record Tools for Integrated Primary Care in Pediatrics

Abstract

Objective: Pediatric Integrated Primary Care (IPC) models include various practice elements, including shared electronic health records (EHRs). Although shared EHR systems provide collaboration opportunities and can be resources for program evaluation and quality improvement initiatives, to be used effectively, EHR tools need to be user-informed and capture the complexities and heterogeneity of behavioral healthcare. The aim of this study was to evaluate the implementation of adapted EHR tools designed to collect relevant, routine data, including presenting concerns, patient history, specific intervention components administered, patient goals and progress, and adherence to protocols. Methods: We describe the design and implementation of three interconnected EHR tools developed to promote the use of practice-based data within an established IPC program. The tools included: (1) a data flowsheet, (2) customizable documentation template, and (3) a real-time data dashboard. The RE-AIM framework guided the identification and evaluation of implementation outcomes including patient reach, provider adoption, and implementation. Behavioral Health Provider (BHP) use of the tools was examined via EHR chart review, and Tableau© tracked access to the data dashboards. Results: Six months after the introduction of the flowsheet and template to BHPs, all utilized the tools in most of their patient encounters. High use rates were sustained three years later (87.56% of encounters). The dashboard tool was never adopted for clinical purposes. Conclusions: While documentation tools were readily adopted, challenges exist in BHP uptake of data visualization tools. Further exploration of factors influencing BHP use of clinical data is essential for advancing practice-based research in pediatric IPC.

Implications for Impact Statement

Our study examined a user-centered approach to designing and adapting existing documentation tools that were tailored to the documentation needs of Integrated Primary Care (IPC) BHPs. Details of the development process and steps for training providers to use the tools are provided to allow Pediatric BHPs to replicate similar EHR changes at their own institutions. We hope that the expansion of more structured and extractable data collection tools within health system EHRs that are designed to capture behavioral health information will promote more practice-based research and allow BHPs to better track clinical outcomes in IPC.