1. Selection Process
Five site visits were planned for this project: two to regional health information organizations (RHIOs), one to an institutional EHR, and two to physician office EHRs.
RHIOs selected for site visits needed to be: 1) fully functional, 2) as complete as possible,
3) representative of how other RHIOs are likely to be organized, and 4) likely to be able to provide good workforce data. These criteria, combined with scheduling and travel considerations, resulted in site visits to Bellingham, Washington, and Indianapolis, Indiana.
For an institutional EHR, a site visit was made to Citizens Memorial Healthcare in Bolivar, Missouri. In addition to an interesting hospital EHR system, they were selected because they are one of the very small number of organizations that have also installed an EHR in their long-term care facilities. In addition, they have experience installing EHRs in physician offices. Finally, their rural location provided some insights into EHR issues outside urban areas.
Site visits to physician EHR systems occurred in Portland, Oregon (the Oregon Community Health Information Network or OCHIN) and Fairfax, Virginia (Fairfax Family Practice). OCHIN was selected because it was a large multi-site EHR focused exclusively on Medicaid and underserved populations. Fairfax Family Practice provided two examples of EHR installations in a single local visit.
2. Issues for Site Visits
After describing the goals, objectives, and methods of study in detail, the key issue for each site visit was soliciting available workforce data that could be used for analysis. While each site visit organization was selected based on the availability of one particular type of workforce data (e.g., physician office EHRs), data for other activity categories was also sometimes available.