Download PDF
Appl Clin Inform 2023; 14(05): 843-854
DOI: 10.1055/a-2150-8523
Research Article

Governance of Electronic Health Record Modification at U.S. Academic Medical Centers

Akshay Ravi
1   Department of Medicine, University of California, San Francisco, San Francisco, California, United States
,
Simone Arvisais-Anhalt
2   Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California, United States
,
Benjamin Weia
1   Department of Medicine, University of California, San Francisco, San Francisco, California, United States
,
Raman Khanna
1   Department of Medicine, University of California, San Francisco, San Francisco, California, United States
,
Julia Adler-Milstein
1   Department of Medicine, University of California, San Francisco, San Francisco, California, United States
,
Andrew Auerbach
1   Department of Medicine, University of California, San Francisco, San Francisco, California, United States
› Author Affiliations Funding This work was the product of an unfunded trainee project.
› Further Information
    Permissions and Reprints

Abstract

Objectives A key aspect of electronic health record (EHR) governance involves the approach to EHR modification. We report a descriptive study to characterize EHR governance at academic medical centers (AMCs) across the United States.

Methods We conducted interviews with the Chief Medical Information Officers of 18 AMCs about the process of EHR modification for standard requests. Recordings of the interviews were analyzed to identify categories within prespecified domains. Responses were then assigned to categories for each domain.

Results At our AMCs, EHR requests were governed variably, with a similar number of sites using quantitative scoring systems (7, 38.9%), qualitative systems (5, 27.8%), or no scoring system (6, 33.3%). Two (11%) organizations formally review all requests for their impact on health equity. Although 14 (78%) organizations have trained physician builders/architects, their primary role was not for EHR build. Most commonly reported governance challenges included request volume (11, 61%), integrating diverse clinician input (3, 17%), and stakeholder buy-in (3, 17%). The slowest step in the process was clarifying end user requests (14, 78%). Few leaders had identified metrics for the success of EHR governance.

Conclusion Governance approaches for managing EHR modification at AMCs are highly variable, which suggests ongoing efforts to balance EHR standardization and maintenance burden, while dealing with a high volume of requests. Developing metrics to capture the performance of governance and quantify problems may be a key step in identifying best practices.

Keywords

electronic health record - clinical governance - qualitative research - EHR governance

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for medical Research Involving Human Subjects and was reviewed by UCSF Institutional Review Board.


Supplementary Material



Publication History

Received: 06 April 2023

Accepted: 07 August 2023

Accepted Manuscript online:
08 August 2023

Article published online:
25 October 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Weill P, Ross JIT. Governance: How Top Performers Manage IT Decision Rights for Superior Results. 1st ed.. Harvard Business Review Press; 2004
    Google Scholar
  • 2 Ash JS, Singh H, Wright A, Chase D, Sittig DF. Essential activities for electronic health record safety: a qualitative study. Health Informatics J 2020; 26 (04) 3140-3151
    CrossrefPubMedGoogle Scholar
  • 3 Shabot MM, Polaschek JX, Duncan RG, Langberg ML, Jones DT. A novel governance system for enterprise information services. Proc AMIA Symp 1999; 619-623
    PubMedGoogle Scholar
  • 4 Fragidis LL, Chatzoglou PD. Implementation of a nationwide electronic health record (EHR). Int J Health Care Qual Assur 2018; 31 (02) 116-130
    CrossrefPubMedGoogle Scholar
  • 5 Aguirre RR, Suarez O, Fuentes M, Sanchez-Gonzalez MA. Electronic health record implementation: a review of resources and tools. Cureus 2019; 11 (09) e5649
    PubMedGoogle Scholar
  • 6 Auerbach AD, Neinstein A, Khanna R. Balancing innovation and safety when integrating digital tools into health care. Ann Intern Med 2018; 168 (10) 733-734
    CrossrefPubMedGoogle Scholar
  • 7 Auerbach A, Burke K, Khanna R. Effective and collegial governance of digital tools in health care. ACI Open 2021; 05 (01) e13-e16
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 McKeeby JWS, , S Coffey P, Houston SM. et al. The evolution of information technology governance at the NIH clinical center. Perspect Health Inf Manag 2021; 18 (03) 1c
    PubMedGoogle Scholar
  • 9 Kannan V, Basit MA, Bajaj P. et al. User stories as lightweight requirements for agile clinical decision support development. J Am Med Inform Assoc 2019; 26 (11) 1344-1354
    CrossrefPubMedGoogle Scholar
  • 10 Chaparro JD, Beus JM, Dziorny AC. et al. Clinical decision support stewardship: best practices and techniques to monitor and improve interruptive alerts. Appl Clin Inform 2022; 13 (03) 560-568
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Electronic Medical Record Adoption Model (EMRAM) | HIMSS. Accessed February 16, 2023 at: https://www.himss.org/what-we-do-solutions/digital-health-transformation/maturity-models/electronic-medical-record-adoption-model-emram
    PubMed
  • 12 Chawla N, Lang R, Michael D, McPeek Hinz E. Understanding clinical governance. Presented at: Epic UGM; 2019. Verona, WI:
    Google Scholar
  • 13 Skelton J, Wilson W. Implementing successful prioritization and governance processes for change requests. Presented at: Epic XGM; 2018. Verona, WI:
    Google Scholar
  • 14 Feen J, Bechard L. Request intake governance that defies the eyes. Presented at: Epic UGM; 2017. Verona, WI:
    Google Scholar
  • 15 Jung J, Nelsen D. Planning the governance and communication intake process. Presented at: Epic UGM; 2018. Verona, WI:
    Google Scholar
  • 16 Acholonu RG, Raphael JL. The influence of the electronic health record on achieving equity and eliminating health disparities for children. Pediatr Ann 2022; 51 (03) e112-e117
    CrossrefPubMedGoogle Scholar
  • 17 James TG, Sullivan MK, Butler JD, McKee MM. Promoting health equity for deaf patients through the electronic health record. J Am Med Inform Assoc 2021; 29 (01) 213-216
    CrossrefPubMedGoogle Scholar
  • 18 AHA Annual Survey DatabaseTM | AHA Data. Accessed January 29, 2023 at: https://www.ahadata.com/aha-annual-survey-database
    PubMed
  • 19 Bansler JP. Challenges in user-driven optimization of EHR: a case study of a large Epic implementation in Denmark. Int J Med Inform 2021; 148: 104394
    CrossrefPubMedGoogle Scholar
  • 20 Najafi N, Robinson A, Pletcher MJ, Patel S. Effectiveness of an analytics-based intervention for reducing sleep interruption in hospitalized patients: a randomized clinical trial. JAMA Intern Med 2022; 182 (02) 172-177
    CrossrefPubMedGoogle Scholar
  • 21 Kharbanda EO, Asche SE, Sinaiko AR. et al. Clinical decision support for recognition and management of hypertension: a randomized trial. Pediatrics 2018; 141 (02) e20172954
    CrossrefPubMedGoogle Scholar
  • 22 Tran AV, Rushakoff RJ, Prasad P, Murray SG, Monash B, Macmaster H. Decreasing hypoglycemia following insulin administration for inpatient hyperkalemia. J Hosp Med 2020; 15 (02) 368-370
    PubMedGoogle Scholar
  • 23 Tokazewski JT, Peifer M, Howell III JT. Leveraging and improving refill protocols at your health system. Appl Clin Inform 2022; 13 (05) 1063-1069
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Cockburn A. Agile software development. Addison-Wesley; 2002
    Google Scholar