Defining Data Migration Across Multidisciplinary Ambulatory Clinics Using Participatory Design
Objective This study aimed to develop an institutional approach for defining data migration based on participatory design principles.
Methods We outline a collaborative approach to define data migration as part of an electronic health record (EHR) transition at an urban hospital with 20 ambulatory clinics, based on participatory design. We developed an institution-specific list of data for migration based on physician end-user feedback. In this paper, we review the project planning phases, multidisciplinary governance, and methods used.
Results Detailed data migration feedback was obtained from 90% of participants. Depending on the specialty, requests for historical laboratory values ranged from 2 to as many as 145 unique laboratory types. Lookback periods requested by physicians varied and were ultimately assigned to provide the most clinical data. This clinical information was then combined to synthesize an overall proposed data migration request on behalf of the institution.
Conclusion Institutions undergoing an EHR transition should actively involve physician end-users and key stakeholders. Physician feedback is vital for developing a clinically relevant EHR environment but is often difficult to obtain. Challenges include physician time constraints and overall knowledge about health information technology. This study demonstrates how a participatory design can serve to improve the clinical end-user's understanding of the technical aspects of an EHR implementation, as well as enhance the outcomes of such projects.
Keywordsparticipatory design - data migration - electronic health record vendor transition - end-user feedback - stakeholder feedback - physician engagement
Protection of Human and Animal Subjects
Institutional Review Board approval was obtained. This work did not involve any interventions in human or animal subjects.
Received: 16 August 2020
Accepted: 27 January 2021
31 March 2021 (online)
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
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- 1 Manwell LB, Williams ES, Babbott S, Rabatin JS, Linzer M. Physician perspectives on quality and error in the outpatient setting. WMJ 2009; 108 (03) 139-144
- 2 Gettinger A, Csatari A. Transitioning from a legacy EHR to a commercial, vendor-supplied, EHR: one academic health system's experience. Appl Clin Inform 2012; 3 (04) 367-376
- 3 West S. Need versus cost: understanding EHR data migration options. J Med Pract Manage 2013; 29 (03) 181-183
- 4 Babbott S, Manwell LB, Brown R. et al. Electronic medical records and physician stress in primary care: results from the MEMO Study. J Am Med Inform Assoc 2014; 21 (e1, E2): e100-e106
- 5 Gierl L, Feistle M, Müller H, Sliva K, Varnholt D, Villain S. Task-specific authoring functions for end-users in a hospital information system. Comput Methods Programs Biomed 1995; 48 (1,2): 145-150
- 6 Kroth PJ, Morioka-Douglas N, Veres S. et al. Association of electronic health record design and use factors with clinician stress and burnout. JAMA Netw Open 2019; 2 (08) e199609
- 7 Paygude P, Devale PR. Automated data validation testing tool for data migration quality assurance. Int J Mod Eng Res 2013; 3 (01) 599-603
- 8 Michel JJ, Hsiao A, Fenick A. Using a scripted data entry process to transfer legacy immunization data while transitioning between electronic medical record systems. Appl Clin Inform 2014; 5 (01) 284-298
- 9 Pageler NM, Grazier G'Sell MJ, Chandler W, Mailes E, Yang C, Longhurst CA. A rational approach to legacy data validation when transitioning between electronic health record systems. J Am Med Informatics Assoc 2016; 23 (05) 991-994
- 10 Meigs SL, Solomon M. Electronic health record use a bitter pill for many physicians. Perspect Heal Inf Manag 2016; 13 (Winter): 1d
- 11 Sinsky C, Colligan L, Li L. et al. Allocation of physician time in ambulatory practice: a time and motion study in 4 specialties. Ann Intern Med 2016; 165 (11) 753-760
- 12 Kwok J, Jones B. Unnecessary repeat requesting of tests: an audit in a government hospital immunology laboratory. J Clin Pathol 2005; 58 (05) 457-462
- 13 Irestig M, Hallberg N, Eriksson H, Timpka T. Peer-to-peer computing in health-promoting voluntary organizations: a system design analysis. J Med Syst 2005; 29 (05) 425-440
- 14 Liu L, Yu E. Designing information systems in social context: A goal and scenario modelling approach. Information Systems 2004; 29 (02) 187-203
- 15 Sanders EB-N. From user-centered to participatory design approaches. In: Frascara J. ed. Design and the Social Sciences: Making Connections. New York, NY: Taylor and Francis; 2002: 1-8
- 16 Puri SK, Byrne E, Nhampossa JL, Quraishi ZB. Contextuality of participation in IS design: a developing country perspective. ACM 2004; 1: 42-52
- 17 Iglehart JK. Reform of the veterans affairs health care system. N Engl J Med 1996; 335 (18) 1407-1411
- 18 Nøhr C, Kuziemsky CE, Elkin PL, Marcilly R, Pelayo S. Sustainable health informatics: health informaticians as alchemists. Stud Health Technol Inform 2019; 256: 3-11
- 19 Scandurra I, Hägglund M, Koch S. From user needs to system specifications: multi-disciplinary thematic seminars as a collaborative design method for development of health information systems. J Biomed Inform 2008; 41 (04) 557-569
- 20 Tang T, Lim ME, Mansfield E, McLachlan A, Quan SD. Clinician user involvement in the real world: Designing an electronic tool to improve interprofessional communication and collaboration in a hospital setting. Int J Med Inform 2018; 110: 90-97
- 21 Clemensen J, Larsen SB, Kyng M, Kirkevold M. Participatory design in health sciences: using cooperative experimental methods in developing health services and computer technology. Qual Health Res 2007; 17 (01) 122-130
- 22 Bossen C. Evaluation of a computerized problem-oriented medical record in a hospital department: does it support daily clinical practice?. Int J Med Inform 2007; 76 (08) 592-600
- 23 Kanstrup AM, Madsen J, Nøhr C, Bygholm A, Bertelsen P. Developments in participatory design of health information technology - a review of PDC publications from 1990 - 2016. Stud Health Technol Inform 2017; 233: 1-13
- 24 Heponiemi T, Hyppönen H, Vehko T. et al. Finnish physicians' stress related to information systems keeps increasing: a longitudinal three-wave survey study. BMC Medical Informatics and Decision Making 2017; 17 (01) DOI: 10.1186/s12911-017-0545-y.
- 25 Kushniruk AW, Nøhr C. Participatory design, user involvement and health IT evaluation. In: Ammenwerth E, Rigby M. eds. Evidence-Based Health Informatics: Promoting Safety and Efficiency through Scientific Methods and Ethical Policy. IOS Press; 2016: 139-151
- 26 Tang T, Heidebrecht C, Coburn A. et al. Using an electronic tool to improve teamwork and interprofessional communication to meet the needs of complex hospitalized patients: a mixed methods study. Int J Med Inform 2019; 127: 35-42
- 27 Ancker JS, Kern LM, Edwards A. et al; HITEC Investigators. How is the electronic health record being used? Use of EHR data to assess physician-level variability in technology use. J Am Med Inform Assoc 2014; 21 (06) 1001-1008
- 28 Dewa CS, Loong D, Bonato S, Trojanowski L. The relationship between physician burnout and quality of healthcare in terms of safety and acceptability: a systematic review. BMJ Open 2017; 7 (06) e015141
- 29 Redd TK, Doberne JW, Lattin D. et al. Variability in electronic health record usage and perceptions among specialty vs. primary care physicians. AMIA Annu Symp Proc 2015; 2015: 2053-2062
- 30 Høstgaard AM, Bertelsen P, Nøhr C. Methods to identify, study and understand end-user participation in HIT development. BMC Med Inform Decis Mak 2011; 11: 57
- 31 Kaplan B, Harris-Salamone KD. Health IT success and failure: recommendations from literature and an AMIA workshop. J Am Med Inform Assoc 2009; 16 (03) 291-299
- 32 Ratwani RM, Savage E, Will A. et al. A usability and safety analysis of electronic health records: a multi-center study. J Am Med Informatics Assoc 2018; 25 (09) 1197-1201
- 33 Kujala S. User involvement: a review of the benefits and challenges. Behav Inf Technol 2003; 22 (01) 1-16
- 34 Van der Velden M, Mörtberg C. Participatory design and design for values. In: van den Hoven J, Vermaas PE, van de Poel I. eds. Handbook of Ethics, Values, and Technological Design: Sources, Theory, Values and Application Domains. The Netherlands: Springer; 2015: 41-66
- 35 Ajami S, Bagheri-Tadi T. Barriers for adopting electronic health records (EHRs) by physicians. Acta Inform Med 2013; 21 (02) 129-134
- 36 Huang ME. IT is from mars and physicians from venus: bridging the gap. 2017; 9 (5S): S19-S25
- 37 Pollack AH, Miller A, Mishra SR, Pratt W. PD-atricians: Leveraging physicians and participatory design to develop novel clinical information tools. AMIA Annu Symp Proc 2016; 2016: 1030-1039