Using Electronic Health Record Systems in Diabetes Care: Emerging Practices.

Area of Science:

• Health Informatics
• Clinical Informatics
• Health Services Research

Background:

• Electronic health record (EHR) system deployment is widely studied, but their actual use in clinical encounters, especially for chronic conditions, is less understood.
• The Department of Veterans' Affairs (VA) offers a mature EHR system and a high prevalence of diabetes, making it a valuable setting for studying EHR use in chronic disease management.

Purpose of the Study:

• To explore how healthcare providers utilize EHR systems during clinical encounters with patients managing complex, chronic illnesses, specifically diabetes.
• To identify emergent categories of EHR use in practice and analyze mismatches between EHR design and clinical workflows.

Main Methods:

• A sequential, exploratory qualitative study was conducted at two Midwest VA Medical Centers.
• Observations of 64 clinical consultations involving 31 healthcare providers and 39 semi-structured interviews with providers focused on EHR information use in diabetes care.
• Grounded theory approach was used to analyze field notes and interview transcripts.

Main Results:

• Five categories of EHR use in clinical encounters were identified: priming, structuring, assessing, informing, and continuing.
• Mismatches between the current EHR system design and the specific practices of VA diabetes care were observed.

Conclusions:

• The study highlights diverse ways EHRs are appropriated in chronic disease care, moving beyond simple data entry.
• Findings suggest implications for improving EHR software design to better support complex, chronic illness management and enhance the integration of technology in healthcare.
• Understanding the practical application of EHRs is crucial for optimizing their role in patient care and health system efficiency.