Colorado Associated Community Health Information Exchange (CACHIE)

The Colorado Associated Community Health Information Exchange project designed, developed, implemented, and evaluated an interoperable quality information system (QIS) for a collaborative network of community health centers (CHCs) with real-time, synchronized quality reporting to inform patient care, quality interventions, and health policy and advocacy efforts.

The main aims of this study were to:

1. Obtain detailed business and technical requirements for development of a flexible, evidence-based, clinical template system that interoperates with four vendor-based electronic health records (EHRs) and a QIS to aggregate and integrate multiple data sources within and across seven community health centers in a timely, efficient manner.
2. Implement a common evidence-based template into the EHR at each CHC practice, based on the business and technical specifications detailed in the previous aim.
3. Guide, support, and evaluate each CHC practice to build capacity and monitor associated costs as they independently, without vendor support, implemented an evidence-based guideline.
4. Implement the QIS detailed in aim 1 to provide quality measure reporting to various stakeholders.
5. Evaluate the usability, utility, accuracy, and best methods for incorporating quality measure reporting as a feedback mechanism for providers and practice managers.

The business process analysis resulted in a comprehensive list of user requirements which were the basis of the technical specifications of the QIS. The user requirements informed vendor selection, contracting, and the vendor's scope of work. Sites did not report any downtime or unintended consequences, but did recognize that creating EHR templates and quality reports is time consuming and that new topics should be added judiciously. Developing consensus on quality metrics, what to report, and how to define the metrics should be done prior to template development. Sites also recognized the importance of understanding workflow process and roles when considering EHR documentation modifications, the importance of making sure that improved documentation results in improved automated assistance, and the value of considering other reporting needs.