Centers Speak Up

The Clinical Context for Health Information Techology in the Ambulatory Care Setting

Health information technology is a critical component for planning for efficient and quality care, but successful implementation requires understanding of the full clinical context. The identification and diagramming of clinical processes in this article aim to improve that understanding.

Clinicians in ambulatory care settings are increasingly called upon to use health information technology (health IT) to improve practice efficiency and performance. This article contributes to our understanding of how health IT will affect clinical tasks and workflows. It draws on in-depth, semi-structured interviews with executives and staff at four community health centers, three health center networks and one large primary care organization. Through systematic characterization of the clinical context, the authors identified six primary clinical domains: results management, intra-clinic communication, patient education and outreach, inter-clinic coordination, medication management and provider education and feedback. They then generated clinical process diagrams to characterize these domains. These process diagrams can serve as the basis for electronic health record (EHR) certification, to identify challenges, to measure health IT adoption, or to develop curricular content regarding the role of health IT in clinical practice.

Policy-makers should consider that providers would benefit from the adoption of well-specified national guideline recommendations and be aware that uniform reporting standards for performance data would permit meaningful comparison across practices. Although the study sites might not represent the full spectrum of clinical contexts, these models can provide a common frame of reference for discussion of health IT systems.