Building an R&D environment to enable HIT-based research in clinical practice

BACKGROUND:The adoption of electronic health records (EHR) has created an opportunity for HIT to re-engineer current chronic disease care processes by enabling viable solutions for routinely delivering patient-centered, evidenced-based care. Rapid innovation in this area is possible using a software development model in which web-based applications (e.g., questionnaires, visual display tools) are separate from, but interact with, the EHR. However, testing new care processes in actual clinical care settings where the EHR is the primary tool for care transactions introduces technical and security-related challenges. PURPOSE:Create a secure research development environment for rapid prototyping and testing of HIT-enabled care processes. METHODS:We convened a working group of IT and research personnel with expertise in security, database design/management, web design, and EHR programming. The group was empowered by leadership to: 1) develop a research-IT infrastructure to maintain network/data security and regulatory compliance while allowing for rapid prototyping; 2) develop an oversight process for managing developer access and application installation reflective of the small scope and scale of prototyping projects. RESULTS:We describe both the technical and organizational challenges and solutions. Three separate, staged server environments were established to allow developers access for building and testing software and implementing it in clinical practice. In a parallel, but far more time-consuming process, an oversight committee was created and granted authority to manage the environment. To date, three pilot projects have been approved and deployed in the clinic setting. Applications include questionnaires for patient-reported data capture, displays of patient treatment preferences, and physician decision support for chronic disease management. CONCLUSIONS:Data resident within EHRs can be leveraged by innovative HIT applications to improve chronic disease care processes. An IT environment allowing secure but rapid prototyping, along with cultural changes/modifications to administrative processes, is required to successfully deploy such applications in clinical practice.