Appl Clin Inform 2023; 14(05): 843-854
DOI: 10.1055/a-2150-8523
Research Article

Governance of Electronic Health Record Modification at U.S. Academic Medical Centers

Akshay Ravi
1   Department of Medicine, University of California, San Francisco, San Francisco, California, United States
Simone Arvisais-Anhalt
2   Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California, United States
Benjamin Weia
1   Department of Medicine, University of California, San Francisco, San Francisco, California, United States
Raman Khanna
1   Department of Medicine, University of California, San Francisco, San Francisco, California, United States
Julia Adler-Milstein
1   Department of Medicine, University of California, San Francisco, San Francisco, California, United States
Andrew Auerbach
1   Department of Medicine, University of California, San Francisco, San Francisco, California, United States
› Author Affiliations
Funding This work was the product of an unfunded trainee project.


Objectives A key aspect of electronic health record (EHR) governance involves the approach to EHR modification. We report a descriptive study to characterize EHR governance at academic medical centers (AMCs) across the United States.

Methods We conducted interviews with the Chief Medical Information Officers of 18 AMCs about the process of EHR modification for standard requests. Recordings of the interviews were analyzed to identify categories within prespecified domains. Responses were then assigned to categories for each domain.

Results At our AMCs, EHR requests were governed variably, with a similar number of sites using quantitative scoring systems (7, 38.9%), qualitative systems (5, 27.8%), or no scoring system (6, 33.3%). Two (11%) organizations formally review all requests for their impact on health equity. Although 14 (78%) organizations have trained physician builders/architects, their primary role was not for EHR build. Most commonly reported governance challenges included request volume (11, 61%), integrating diverse clinician input (3, 17%), and stakeholder buy-in (3, 17%). The slowest step in the process was clarifying end user requests (14, 78%). Few leaders had identified metrics for the success of EHR governance.

Conclusion Governance approaches for managing EHR modification at AMCs are highly variable, which suggests ongoing efforts to balance EHR standardization and maintenance burden, while dealing with a high volume of requests. Developing metrics to capture the performance of governance and quantify problems may be a key step in identifying best practices.

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for medical Research Involving Human Subjects and was reviewed by UCSF Institutional Review Board.

Supplementary Material

Publication History

Received: 06 April 2023

Accepted: 07 August 2023

Accepted Manuscript online:
08 August 2023

Article published online:
25 October 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

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