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Assessing organizational capacity for achieving meaningful use of electronic health records
Christopher M Shea1, Robb Malone, Morris Weinberger
1Christopher M. Shea, PhD, MPA, is Assistant Professor of Health Policy and Management, University of North Carolina, Chapel Hill, North Carolina. E-mail: Chris_Shea@unc.edu. Robb Malone, PharmD, CPP, is Vice President, Department of Practice Quality and Innovation, UNC Health Care, Chapel Hill, North Carolina. Morris Weinberger, PhD, is Professor of Health Policy and Management, University of North Carolina, Chapel Hill, North Carolina, and Senior Research Career Scientist, Durham VAMC Center for Health Services Research, Durham, North Carolina. Kristin L. Reiter, PhD, is Associate Professor of Health Policy and Management, University of North Carolina, Chapel Hill, North Carolina. Jonathan Thornhill, MS, is Manager, Department of Practice Quality and Innovation, UNC Health Care, Chapel Hill, North Carolina. Jennifer Lord, is Meaningful Use Project Manager, UNC Health Care, Chapel Hill, North Carolina. Nicholas G. Nguyen, MHA, is Administrative Fellow, Division of Surgical Sciences, Wake Forest Baptist Medical Center, Winston-Salem, NorthCarolina. Bryan J. Weiner, PhD, is Professor of Health Policy and Management, University of North Carolina, Chapel Hill, North Carolina.
Background:
Health care institutions are scrambling to manage the complex organizational change required for achieving meaningful use (MU) of electronic health records (EHR). Assessing baseline organizational capacity for the change can be a useful step toward effective planning and resource allocation.
Purpose:
The aim of this article is to describe an adaptable method and tool for assessing organizational capacity for achieving MU of EHR. Data on organizational capacity (people, processes, and technology resources) and barriers are presented from outpatient clinics within one integrated health care delivery system; thus, the focus is on MU requirements for eligible professionals, not eligible hospitals.
Methods:
We conducted 109 interviews with representatives from 46 outpatient clinics.
Findings:
Most clinics had core elements of the people domain of capacity in place. However, the process domain was problematic for many clinics, specifically, capturing problem lists as structured data and having standard processes for maintaining the problem list in the EHR. Also, nearly half of all clinics did not have methods for tracking compliance with their existing processes. Finally, most clinics maintained clinical information in multiple systems, not just the EHR. The most common perceived barriers to MU for eligible professionals included EHR functionality, changes to workflows, increased workload, and resistance to change.
Practice Implications:
Organizational capacity assessments provide a broad institutional perspective and an in-depth clinic-level perspective useful for making resource decisions and tailoring strategies to support the MU change effort for eligible professionals.
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