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Play 10: EHR Modification

Electronic Health Record Modification


Your electronic health record (EHR) is the critical tool for implementing, sustaining, and improving S·BI·RT. New Hampshire S·BI·RT sites have worked to modify a variety of EHRs including Epic, Centricity (CHAN), eMDs, and others.

Purpose of Play 10 To support consideration of uses for the EHR throughout the S·BI·RT process.
Definitions This play is not a “how to”. It is included to ensure consideration of the myriad ways that your EHR might be helpful to your site in ensuring that all components of the S•BI•RT process are completed and documented.
Team members Including the person who will be creating and/or communicating about the required changes in your EHR from the beginning is essential.
Measure(s) Success may include things such as no additional staff time for screening or data entry, prompts which practitioners utilize and find helpful, automatically updated local referral list from website included in EHR, automatic prompts to follow up on positive screens/brief interventions at subsequent appointments, etc.


Recommended Approach

Consider the following given the capacity of your EHR to automate, remind, encourage, and report:

  • Screening – Incorporating the screening tool is the lowest level of utilization of the EHR. Can it then score and recommend next steps based on that score?
  • Brief Intervention – Can you create practitioner supports (best practice guidelines or clinical decision supports) within your EHR that not only recommend next steps based on screening results but also capture data for reporting and quality improvement (QI)?
  • Referral to Treatment – Can your EHR receive information regarding patient progress from the referral site? If information is not received within an identified number of days, can it automatically generate a reminder?
  • Follow up – How can you use your EHR to document the outcome of brief intervention and set reminders at the next visit?
  • Confidentiality – How will you maintain the confidentiality of your young patients’ drug and alcohol information from parents in the portal? From record requests? Do you effectively use the confidential capacity of your EHR? Should you use it for drug and alcohol use information? For screening results positive or negative? For follow ups to brief intervention?
  • Flow – How can your EHR facilitate streamlining flow and not adding to staff time? Can you incorporate tablets that will automatically populate your chart?
  • Quality Planning and Data – How will you pull data for reporting? Are there other data that your team wants to track for quality improvement (QI)? How will you receive feedback from flow staff as to the utility of the EHR screens after initial rollout? How will you decide to update or improve?
  • Training – How will you incorporate the S·BI·RT screens in your EHR into “booster” and new staff training?

Keep In Mind

  • Other NH sites already implementing S·BI·RT may utilize the same EHR. The Center can connect you to other users, provide screen shots, and help your team maximize the use of your EHR. Screen shots of NH S·BI·RT Initiative EHRs are available in Appendix Q.

Corresponding Appendix Section(s)

Appendix Q – Screen Shots of NH S•BI•RT Initiative EHRs

» Continue to PLAY 11: QI and Data Collection