Clinical Information Needs of Community Health Centers for Health Information Technology

Managing patient information can be difficult when serving patients with multiple physical, mental, and social needs, particularly when cared for by multiple providers. When coordinating care for such patients, primary care providers must locate, obtain, and synthesize a wide range of information to assess patients, make clinical decisions, monitor progress, and identify care goals. They also must identify the people involved in the patient’s care and share information effectively, including within and across care settings. Likewise important is the collection of social determinants of health to guide clinicians in their management plans.

Health information technology (IT) tools that optimally support information capture, access, management, and sharing required for effective care coordination are critical to addressing this set of information needs. The research team sought to better understand information needs of care teams, including collection of social determinants of health data, to inform the creation of design principles to support information management and care coordination.

The specific aims of this research were as follows:

• Identify community health center (CHC) clinicians’ and clinical teams’ information needs when they work individually and collaboratively to coordinate care for complex patients. 
• Identify CHC clinicians’ and clinical teams’ information needs regarding patients’ social determinants of health, and methods for obtaining this information and integrating it into the electronic health record (EHR) to inform clinical decision making when caring for complex patients. 
• Identify design principles and use proven development methods to rapidly develop and test IT tools to meet the IT needs identified in the prior two aims. 

The research team conducted a mixed methods study, including observations of care teams of CHCs using the EHR, as well as interviews and surveys of clinic staff. Four categories of information needs were identified: (1) consistency of social determinants of health documentation, (2) prioritization of social determinants of health information, (3) referral management for social and economic needs, and (4) communication of social determinants of health information. Based on these findings, the researchers defined the following EHR design principles: enhance the flexibility of EHR documentation workflows, expand the ability to exchange information within teams and between systems, balance innovation and standardization of EHR systems, organize and simplify information displays, and prioritize and reduce information. These design principles were subsequently used to inform revision of the OCHIN EHR social determinants of health tool set and the development of a prototype for collecting these data. Usability testing of the prototype among clinical team members indicated the prototype would be effective and easy to use.