{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,12]],"date-time":"2026-04-12T01:34:20Z","timestamp":1775957660604,"version":"3.50.1"},"reference-count":55,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2020,3,5]],"date-time":"2020-03-05T00:00:00Z","timestamp":1583366400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["1R01HS023324-01A1"],"award-info":[{"award-number":["1R01HS023324-01A1"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,5,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To identify the unmet information needs of clinical teams delivering care to patients with complex medical, social, and economic needs; and to propose principles for redesigning electronic health records (EHR) to address these needs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>In this observational study, we interviewed and observed care teams in 9 community health centers in Oregon and Washington to understand their use of the EHR when caring for patients with complex medical and socioeconomic needs. Data were analyzed using a comparative approach to identify EHR users\u2019 information needs, which were then used to produce EHR design principles.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Analyses of &amp;gt; 300 hours of observations and 51 interviews identified 4 major categories of information needs related to: consistency of social determinants of health (SDH) documentation; SDH information prioritization and changes to this prioritization; initiation and follow-up of community resource referrals; and timely communication of SDH information. Within these categories were 10 unmet information needs to be addressed by EHR designers. We propose the following EHR design principles to address these needs: enhance the flexibility of EHR documentation workflows; expand the ability to exchange information within teams and between systems; balance innovation and standardization of health information technology systems; organize and simplify information displays; and prioritize and reduce information.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Developing EHR tools that are simple, accessible, easy to use, and able to be updated by a range of professionals is critical. The identified information needs and design principles should inform developers and implementers working in community health centers and other settings where complex patients receive care.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jamia\/ocaa010","type":"journal-article","created":{"date-parts":[[2020,1,17]],"date-time":"2020-01-17T04:28:42Z","timestamp":1579235322000},"page":"690-699","source":"Crossref","is-referenced-by-count":18,"title":["Unmet information needs of clinical teams delivering care to complex patients and design strategies to address those needs"],"prefix":"10.1093","volume":"27","author":[{"given":"Deborah J","family":"Cohen","sequence":"first","affiliation":[{"name":"Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA"},{"name":"Department of Medical Informatics and Clinical Epidemiology, OregonHealth and Science University, Portland, Oregon, USA"}]},{"given":"Tamar","family":"Wyte-Lake","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA"}]},{"given":"David A","family":"Dorr","sequence":"additional","affiliation":[{"name":"Department of Medical Informatics and Clinical Epidemiology, OregonHealth and Science University, Portland, Oregon, USA"}]},{"given":"Rachel","family":"Gold","sequence":"additional","affiliation":[{"name":"Center for Health Research, Kaiser Permanente, Portland, Oregon, USA"},{"name":"Department of Research, OCHIN Inc, Portland, Oregon, USA"}]},{"given":"Richard J","family":"Holden","sequence":"additional","affiliation":[{"name":"Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA"}]},{"given":"Richelle J","family":"Koopman","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, USA"}]},{"given":"Joshua","family":"Colasurdo","sequence":"additional","affiliation":[{"name":"Department of Medical Informatics and Clinical Epidemiology, OregonHealth and Science University, Portland, Oregon, USA"}]},{"given":"Nathaniel","family":"Warren","sequence":"additional","affiliation":[{"name":"Department of Research, OCHIN Inc, Portland, Oregon, USA"}]}],"member":"286","published-online":{"date-parts":[[2020,3,5]]},"reference":[{"issue":"5","key":"2020110613103962300_ocaa010-B1","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1370\/afm.1840","article-title":"Primary care physician insights into a typology of the complex patient in primary care","volume":"13","author":"Loeb","year":"2015","journal-title":"Ann Fam Med"},{"key":"2020110613103962300_ocaa010-B2","doi-asserted-by":"crossref","first-page":"S7","DOI":"10.1097\/MLR.0000000000000045","article-title":"A conceptual model of the role of complexity in the care of patients with multiple chronic conditions","volume":"52","author":"Grembowski","year":"2014","journal-title":"Med Care"},{"issue":"S3","key":"2020110613103962300_ocaa010-B3","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1007\/s11606-007-0307-0","article-title":"Patient complexity: more than comorbidity. the vector model of complexity","volume":"22","author":"Safford","year":"2007","journal-title":"J Gen Intern Med"},{"issue":"12","key":"2020110613103962300_ocaa010-B4","doi-asserted-by":"crossref","first-page":"1741","DOI":"10.1007\/s11606-015-3357-8","article-title":"Evaluating a model to predict primary care physician-defined complexity in a large academic primary care practice-based research network","volume":"30","author":"Hong","year":"2015","journal-title":"J Gen Intern Med"},{"issue":"2","key":"2020110613103962300_ocaa010-B5","doi-asserted-by":"crossref","first-page":"229","DOI":"10.2105\/AJPH.2014.302257","article-title":"The National Prevention Strategy: leveraging multiple sectors to improve population health","volume":"105","author":"Lushniak","year":"2015","journal-title":"Am J Public Health"},{"issue":"6","key":"2020110613103962300_ocaa010-B6","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1177\/003335491112600602","article-title":"The national prevention strategy: shifting the nation\u2019s health-care system","volume":"126","author":"Benjamin","year":"2011","journal-title":"Public Health Rep"},{"key":"2020110613103962300_ocaa010-B7","volume-title":"Achieving health equity: a guide for health care organizations","author":"Wyatt","year":"2016"},{"key":"2020110613103962300_ocaa010-B8","year":"2019"},{"key":"2020110613103962300_ocaa010-B9","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.ijmedinf.2018.02.003","article-title":"Physicians\u2019 perceptions of the impact of the EHR on the collection and retrieval of psychosocial information in outpatient diabetes care","volume":"113","author":"Senteio","year":"2018","journal-title":"Int J Med Inform"},{"issue":"12","key":"2020110613103962300_ocaa010-B10","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1016\/j.ijmedinf.2015.09.004","article-title":"The EHR and building the patient\u2019s story: a qualitative investigation of how EHR use obstructs a vital clinical activity","volume":"84","author":"Varpio","year":"2015","journal-title":"Int J Med Inform"},{"issue":"10","key":"2020110613103962300_ocaa010-B11","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1177\/0009922812441663","article-title":"Identifying social risk via a clinical social history embedded in the electronic health record","volume":"51","author":"Beck","year":"2012","journal-title":"Clin Pediatr (Phila)"},{"key":"2020110613103962300_ocaa010-B12","author":"Zhou","year":"4\u20139, 2009; ,"},{"issue":"1","key":"2020110613103962300_ocaa010-B13","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1093\/jamia\/ocx130","article-title":"Assessing the capacity of social determinants of health data to augment predictive models identifying patients in need of wraparound social services","volume":"25","author":"Kasthurirathne","year":"2018","journal-title":"J Am Med Inform Assoc"},{"issue":"1","key":"2020110613103962300_ocaa010-B14","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1093\/jamia\/ocx059","article-title":"Mining 100 million notes to find homelessness and adverse childhood experiences: 2 case studies of rare and severe social determinants of health in electronic health records","volume":"25","author":"Bejan","year":"2018","journal-title":"J Am Med Inform Assoc"},{"issue":"2","key":"2020110613103962300_ocaa010-B15","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1093\/jamia\/ocv088","article-title":"Community vital signs\u201d: incorporating geocoded social determinants into electronic records to promote patient and population health","volume":"23","author":"Bazemore","year":"2016","journal-title":"J Am Med Inform Assoc"},{"key":"2020110613103962300_ocaa010-B16","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1093\/jamia\/ocz053","article-title":"Psychosocial information use for clinical decisions in diabetes care","author":"Senteio","year":"2019","journal-title":"J Am Med Inform Assoc"},{"issue":"11","key":"2020110613103962300_ocaa010-B17","doi-asserted-by":"crossref","first-page":"1068","DOI":"10.1016\/j.ijmedinf.2013.08.007","article-title":"Use of a human factors approach to uncover informatics needs of nurses in documentation of care","volume":"82","author":"Rogers","year":"2013","journal-title":"Int J Med Inform"},{"issue":"6","key":"2020110613103962300_ocaa010-B18","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1136\/jamia.2010.005637","article-title":"Health information technology: fallacies and sober realities","volume":"17","author":"Karsh","year":"2010","journal-title":"J Am Med Inform Assoc"},{"issue":"10","key":"2020110613103962300_ocaa010-B19","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1002\/(SICI)1097-4571(199512)46:10<729::AID-ASI3>3.0.CO;2-2","article-title":"Information needs of physicians","volume":"46","author":"Gorman","year":"1995","journal-title":"J Am Soc Inform Sci"},{"key":"2020110613103962300_ocaa010-B20"},{"issue":"1","key":"2020110613103962300_ocaa010-B21","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1215\/03616878-1898794","article-title":"Who governs federally qualified health centers?","volume":"38","author":"Wright","year":"2013","journal-title":"J Health Polit Policy Law"},{"issue":"4","key":"2020110613103962300_ocaa010-B22","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1370\/afm.2385","article-title":"Following uninsured patients through medicaid expansion: ambulatory care use and diagnosed conditions","volume":"17","author":"Huguet","year":"2019","journal-title":"Ann Fam Med"},{"key":"2020110613103962300_ocaa010-B23","article-title":"Translating Research into Agile Development (TRIAD): development of electronic health record tools for primary care settings","author":"Clark","journal-title":"Methods Inf Med"},{"key":"2020110613103962300_ocaa010-B24","year":"2017"},{"key":"2020110613103962300_ocaa010-B25","year":"2020"},{"issue":"11","key":"2020110613103962300_ocaa010-B26","doi-asserted-by":"crossref","first-page":"1669","DOI":"10.1080\/00140139.2013.838643","article-title":"SEIPS 2.0: a human factors framework for studying and improving the work of healthcare professionals and patients","volume":"56","author":"Holden","year":"2013","journal-title":"Ergonomics"},{"key":"2020110613103962300_ocaa010-B27","volume-title":"Rapid Assessment Process: An Introduction","author":"Beebe","year":"2001"},{"issue":"10","key":"2020110613103962300_ocaa010-B28","first-page":"881","article-title":"Understanding practice from the ground up","volume":"50","author":"Crabtree","year":"2001","journal-title":"J Fam Pract"},{"issue":"4","key":"2020110613103962300_ocaa010-B29","doi-asserted-by":"crossref","first-page":"299","DOI":"10.3414\/ME10-01-0042","article-title":"Rapid assessment of clinical information systems in the healthcare setting: an efficient method for time-pressed evaluation","volume":"50","author":"McMullen","year":"2011","journal-title":"Methods Inf Med"},{"issue":"4","key":"2020110613103962300_ocaa010-B30","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1370\/afm.818","article-title":"Evaluative criteria for qualitative research in health care: controversies and recommendations","volume":"6","author":"Cohen","year":"2008","journal-title":"Ann Fam Med"},{"key":"2020110613103962300_ocaa010-B31","volume-title":"R: A Language and Environment for Statistical Computing [Program]","year":"2019"},{"key":"2020110613103962300_ocaa010-B32","author":"Adler","year":"2016"},{"key":"2020110613103962300_ocaa010-B33","doi-asserted-by":"crossref","DOI":"10.4324\/9781498757461","volume-title":"Improving Outcomes with Clinical Decision Support: An Implementer\u2019s Guide","author":"Osheroff","year":"2012","edition":"2nd ed."},{"key":"2020110613103962300_ocaa010-B34","author":"Nielsen"},{"key":"2020110613103962300_ocaa010-B35","author":"Lowry","year":"2012"},{"issue":"2","key":"2020110613103962300_ocaa010-B36","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1080\/10852352.2014.973251","article-title":"Food Rx: a community\u2013university partnership to prescribe healthy eating on the South Side of Chicago","volume":"43","author":"Goddu","year":"2015","journal-title":"J Prev Interv Commun"},{"issue":"6","key":"2020110613103962300_ocaa010-B37","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1093\/jamia\/ocy004","article-title":"Closing the loop with an enhanced referral management system","volume":"25","author":"Ramelson","year":"2018","journal-title":"J Am Med Inform Assoc"},{"issue":"1","key":"2020110613103962300_ocaa010-B38","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1093\/jamia\/ocw040","article-title":"Health information exchange in the wild: the association between organizational capability and perceived utility of clinical event notifications in ambulatory and community care","volume":"24","author":"Vest","year":"2017","journal-title":"J Am Med Inform Assoc"},{"issue":"e1","key":"2020110613103962300_ocaa010-B39","doi-asserted-by":"crossref","first-page":"e213","DOI":"10.1093\/jamia\/ocu031","article-title":"Technical infrastructure implications of the patient work framework","volume":"22","author":"Valdez","year":"2015","journal-title":"J Am Med Inform Assoc"},{"issue":"6","key":"2020110613103962300_ocaa010-B40","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1136\/amiajnl-2011-000249","article-title":"Evaluating health information technology in community-based settings: lessons learned","volume":"18","author":"Kern","year":"2011","journal-title":"J Am Med Inform Assoc"},{"key":"2020110613103962300_ocaa010-B41","author":"Cartier"},{"key":"2020110613103962300_ocaa010-B42","year":"2019"},{"key":"2020110613103962300_ocaa010-B43"},{"key":"2020110613103962300_ocaa010-B44","author":"Zhou"},{"key":"2020110613103962300_ocaa010-B45","first-page":"287","volume-title":"Clinical informatics study guide. In: Finnell JT, Dixon BE, eds. Human Factors Engineering and Human\u2013Computer Interaction: supporting User Performance and Experience","author":"Holden","year":"2016"},{"key":"2020110613103962300_ocaa010-B46","volume-title":"Usability Engineering","author":"Nielsen","year":"1994"},{"key":"2020110613103962300_ocaa010-B47","first-page":"24","volume-title":"Designing the user interface: strategies for effective human-computer interaction","author":"Zeng","year":"2009"},{"issue":"6","key":"2020110613103962300_ocaa010-B48","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.1016\/j.jbi.2011.08.005","article-title":"TURF: toward a unified framework of EHR usability","volume":"44","author":"Zhang","year":"2011","journal-title":"J Biomed Inform"},{"issue":"4","key":"2020110613103962300_ocaa010-B49","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1377\/hlthaff.2017.1252","article-title":"Integrating data on social determinants of health into electronic health records","volume":"37","author":"Cantor","year":"2018","journal-title":"Health Aff"},{"issue":"4","key":"2020110613103962300_ocaa010-B50","doi-asserted-by":"crossref","first-page":"428","DOI":"10.3122\/jabfm.2017.04.170046","article-title":"Developing electronic health record (EHR) strategies related to health center patients\u2019 social determinants of health","volume":"30","author":"Gold","year":"2017","journal-title":". J Am Board Fam Med"},{"issue":"e1","key":"2020110613103962300_ocaa010-B51","doi-asserted-by":"crossref","first-page":"e78","DOI":"10.1136\/amiajnl-2013-001686","article-title":"A typology of electronic health record workarounds in small-to-medium size primary care practices","volume":"21","author":"Friedman","year":"2014","journal-title":"J Am Med Inform Assoc"},{"issue":"4","key":"2020110613103962300_ocaa010-B52","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1197\/jamia.M2616","article-title":"Workarounds to barcode medication administration systems: their occurrences, causes, and threats to patient safety","volume":"15","author":"Koppel","year":"2008","journal-title":"J Am Med Inform Assoc"},{"issue":"2","key":"2020110613103962300_ocaa010-B53","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1097\/HMR.0b013e3181d116c2","article-title":"Rework and workarounds in nurse medication administration process: implications for work processes and patient safety","volume":"35","author":"Halbesleben","year":"2010","journal-title":"Health Care Manage Rev"},{"issue":"3","key":"2020110613103962300_ocaa010-B54","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1177\/0018720818762546","article-title":"Workarounds to intended use of health information technology: a narrative review of the human factors engineering literature","volume":"60","author":"Patterson","year":"2018","journal-title":"Hum Factors"},{"key":"2020110613103962300_ocaa010-B55","author":"Veinot","year":"2010"}],"container-title":["Journal of the American Medical Informatics Association"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jamia\/article-pdf\/27\/5\/690\/34153307\/ocaa010.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jamia\/article-pdf\/27\/5\/690\/34153307\/ocaa010.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,11,6]],"date-time":"2020-11-06T19:34:41Z","timestamp":1604691281000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jamia\/article\/27\/5\/690\/5782071"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3,5]]},"references-count":55,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2020,3,5]]},"published-print":{"date-parts":[[2020,5,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jamia\/ocaa010","relation":{},"ISSN":["1527-974X"],"issn-type":[{"value":"1527-974X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,5]]},"published":{"date-parts":[[2020,3,5]]}}}