Pre-Implementation Case Studies Evaluating Workflow and Informatics Challenges in Private Primary Care Clinics for Electronic Medical Record Implementation

Despite the potential benefits of electronic medical records (EMRs), their implementations have failed in a number of instances because of misfit between the technology design, work practices, workflows, and clinicians' needs. To promote effective design and implementation of an EMR system, the present pre-implementation study modeled the clinical workflow processes in private primary health care clinics and identified the associated gaps, weaknesses, and informatics challenges in the processes. Systematic field observations were performed to collect workflow data. Forty-three health care professionals (16 physicians and 27 clinical assistants) of fifteen private primary health care clinics were studied. The results, presented in a workflow diagram, demonstrate step-by-step details of the clinical work processes, their gaps and weaknesses, and possible improvement opportunities offered by the application of EMR. The workflow model provides important implications that may be applicable to other health care settings that plan to implement EMRs.