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Electronic Health Record Implementation Findings at a Large, Suburban Health and Human Services Department

Crowley, Kenyon MBA, MS, CPHIMS; Mishra, Anubhuti MS; Cruz-Cano, Raul PhD; Gold, Robert PhD; Kleinman, Dushanka DDS; Agarwal, Ritu PhD

Journal of Public Health Management and Practice: January/February 2019 - Volume 25 - Issue 1 - p E11–E16
doi: 10.1097/PHH.0000000000000768
Research Reports: Research Full Report

Objective: Evaluate an electronic health record (EHR) implementation across a large public health department to better understand and improve implementation effectiveness of EHRs in public health departments.

Design: A survey based on Consolidated Framework for Implementation Research constructs was administered to staff before and after implementation of an EHR.

Setting: Large suburban county department of health and human services that provides clinical, behavioral, social, and oral health services.

Participants: Staff across 4 program areas completed the survey prior to EHR implementation (n = 331, June 2014) and 3 months post-EHR final implementation (n = 229, December 2015).

Intervention: Electronic health record

Main Outcome Measures: Constructs were validated using confirmatory factor analysis and included information strengths and information gaps in the current environment; EHR impacts; ease of use; future use intentions; usefulness; knowledge of system; and training. Paired t tests and Wilcoxon signed rank tests of a matched sample were performed to compare the pre-/postrespondent scores.

Results: A majority of user perceptions and expectations showed a significant (P < .05) decline 3 months postimplementation as compared with the baseline with variation by service area and construct. Staff perceived the EHR to be less useful and more complex, provide fewer benefits, and reduce information access shortly after implementation.

Conclusions: Electronic health records can benefit public health practices in many ways; however, public health departments will face significant challenges incorporating EHRs, which are typically designed for non–public health settings, into the public health workflow. Electronic health record implementation recommendations for health departments are provided. When implementing an EHR in a public health setting, health departments should provide extensive preimplementation training opportunities, including EHR training tailored to job roles, competencies, and tasks; assess usability and specific capabilities at a more granular level as part of procurement processes and consider using contracting language to facilitate usability, patient safety, and related evaluations to enhance effectiveness and efficiencies and make results public; apply standard terminologies, processes, and data structures across different health department service areas using common public health terminologies; and craft workforce communication campaigns that balance potential expected benefits with realistic expectations.

Center for Health Information & Decision Systems, Decision, Operations and Information Technologies Department, Robert H. Smith School of Business, University of Maryland (Mr Crowley, Ms Mishra, and Dr Agarwal) and University of Maryland iSchool, College Park, Maryland (Mr Crowley); ICF International, Fairfax, Virginia (Ms Mishra); and Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, Maryland (Drs Cruz-Cano, Gold, and Kleinman).

Correspondence: Kenyon Crowley, MBA, MS, CPHIMS, Center for Health Information & Decision Systems, Robert H. Smith School of Business, University of Maryland, 4332P Van Munching Hall, College Park, MD 20742 (

The authors declare no conflicts of interest.

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