This Article Full Text Full Text (PDF) Data Supplement All Versions of this Article: M2234v1 14/2/191    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sequist, T. D. Articles by Bates, D. W. Search for Related Content PubMed PubMed Citation Articles by Sequist, T. D. Articles by Bates, D. W.

Implementation and Use of an Electronic Health Record within the Indian Health Service

^a Division of General Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA
^b Department of Health Care Policy, Harvard Medical School, Boston, MA
^c Department of Ambulatory Care and Prevention, Harvard Medical School, Boston, MA
^d Harvard Pilgrim Health Care, Boston, MA
^e Indian Health Service Office of Information Technology, Phoenix, AZ
^f Seattle Indian Health Board, Seattle, WA.

^_* Correspondence and reprints: Thomas D. Sequist, MD, MPH, BWH Division of General Medicine, 1620 Tremont Street, Boston, MA 02120. (Email: tsequist{at}partners.org).

Received for publication: 07/31/06; accepted for publication: 12/11/06.

Objectives: There are limited data regarding implementing electronic health records (EHR) in underserved settings. We evaluated the implementation of an EHR within the Indian Health Service (IHS), a federally funded health system for Native Americans.

Design: We surveyed 223 primary care clinicians practicing at 26 IHS health centers that implemented an EHR between 2003 and 2005.

Methods: The survey instrument assessed clinician attitudes regarding EHR implementation, current utilization of individual EHR functions, and attitudes regarding the use of information technology to improve quality of care in underserved settings. We fit a multivariable logistic regression model to identify correlates of increased utilization of the EHR.

Results: The overall response rate was 56%. Of responding clinicians, 66% felt that the EHR implementation process was positive. One-third (35%) believed that the EHR improved overall quality of care, with many (39%) feeling that it decreased the quality of the patient–doctor interaction. One-third of clinicians (34%) reported consistent use of electronic reminders, and self-report that EHRs improve quality was strongly associated with increased utilization of the EHR (odds ratio 3.03, 95% confidence interval 1.05–8.8). The majority (87%) of clinicians felt that information technology could potentially improve quality of care in rural and underserved settings through the use of tools such as online information sources, telemedicine programs, and electronic health records.

Conclusions: Clinicians support the use of information technology to improve quality in underserved settings, but many felt that it was not currently fulfilling its potential in the IHS, potentially due to limited use of key functions within the EHR.

This article has been cited by other articles:

				P. Charney Computer Technology and the Nutrition Support Professional: Make It Work For You! Nutr Clin Pract, August 1, 2007; 22(4): 421 - 427. [Abstract] [Full Text] [PDF]