Overcoming Barriers to Implementation of Electronic Health Records in an HIV Clinic

Background: Electronic Health Records (EHR) implementation is a complex process; this is especially true when converting clinical data from a paper format into an electronic version. Due to the nature of HIV/AIDS and it's treatment, accurate conversion of documentation is critical. Better preparation of data sources and consideration of technical processes help overcome barriers and make EHR transition smoother.

Objectives: 1) to assess the barriers to implementation of EHR; 2) to discuss the solutions and lessons learned for overcoming barriers and establish a smoother conversion.

Methods: Conversion of paper antiretroviral (ARV) medication records to electronic format started in 2004, involving a multi-disciplinary team of physicians, IT experts/programmers, and clinic administrators. All paper ARV medication records since 1994 were converted to electronic format.

Results: About 15,545 ARV medication records were converted into electronic format within a two year period. Several barriers to ARV medication conversion were identified: illegibility of hand written prescriptions in the paper records, multi-versions (n=1,238) of medication formats, and lack of standards for medical records entry. Selected key solutions/lessons learned are: before conversion to the EHR, data needs to be prioritized, organized, refined, and quality checks implemented. Outcomes include, well designed automation, better communication with providers and enhanced research study feedback from EHR users.

Discussion: Accuracy and efficiency of conversion to EHR is important and a critical issue for both clinical patient care and research. Resolving the barriers before and during the conversion process improves the data quality and standardization of the EHR data.