Rural Iowa Redesign of Care Delivery with EHR Functions (Iowa)


The purpose of this project was to evaluate the impact of implementing electronic health record (EHR) functions on patient care and organizational culture in rural health care hospital inpatient units, ambulatory care, and two primary care clinics. The partners implemented a comprehensive integrated EHR using computerized provider order entry (CPOE), interdisciplinary documentation, medication administration scanning, and clinical decision support (CDS) tools in a planned one-day "big-bang" approach. A time-series design was used to evaluate effect on reported errors (medication errors); CMS/ Joint Commission quality measures; computerized ordering and decision support tools; emergency length of stay; and clinician/staff assessment of the implementation process and how the EHR has changed the quality and safety of patient care, communication among clinicians and patients; and daily work life. After thirty months the hospital and clinics had sustained a 70 percent CPOE rate with over 250 evidence-based order sets; 76 CDS rules; redesigned all patient-centered workflow processes to include quick registration, up-to-date medication lists, technical and content safety and error-prevention designs with required documentation. The partners improved timely antibiotic use and patient education CMS indicators while maintained others in the top quartile; maintained organizational engagement; and found no untoward consequences during the changes.

Grant Number: 
UC1 HS015196
Funding Mechanism: 
Transforming Healthcare Quality Through Information Technology (THQIT) - Implementation Grants
AHRQ Funded Amount: 
Principal Investigator: 
Crandall, Donald
Mercy Medical Center North Iowa
Mason City
Project Dates: 
September 30, 2004 to December 31, 2007
Project Status: 

Project Categories

Type of Health Information Technology: 
Clinical Decision Support (CDS) System
Computerized Provider Order Entry (CPOE)
Electronic Medical Record (EMR)/Electronic Health Record (EHR)
Wide Area Network
Care Setting: 
Aspect of Care: 
Acute Care
Medication Management
Protected Health Information Data Sharing
Quality Measurement/Quality Improvement
Target Population: 
Chronic Care
Congestive Heart Failure (CHF)
Coronary Artery Disease
Rural Health
Last Modified: August 2015

News and Publications

Crandall DK. Rural Iowa Redesign of Care Delivery with EHR Functions - Final Report. (Prepared by Mercy Medical Center North Iowa under Grant No. UC1 HS015196). Rockville, MD: Agency for Healthcare Research and Quality, 2008. (PDF, 144.65 KB)
The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.