Implementation of electronic health records (EHRs) is a driver for the improvement of health care and the reduction of health care costs. Developing countries face substantial challenges in adopting EHRs. The complex adaptive system conceptual framework was used to guide this single case study to explore strategies that health care leaders used to successfully implement the EHR system. Data were collected from 6 health care leaders from an island in the Caribbean using a semistructured interview technique. Data were analyzed using the Bengtsson's 4-stage data analysis process, which includes decontextualization, recontextualization, categorization, and compilation. The results of the study yielded 5 main themes: training, increased staffing, monitoring, identifying organizational gaps, and time. The implications of the study for positive social change include the potential to improve the standards of care provided to promote improved patient outcomes by using the strategies identified in this study to successfully implement the EHR system.

Health portals are dedicated web pages for medical practices to provide patients access to their electronic health records. The problem identified in this quality improvement project was that the health portal in the urgent care setting had not been available to staff nor patients. To provide leadership with information related to opening the portal, the first purpose of the project was to assess staff and patients' perceived use, ease of use, attitude toward using, and intention to use the portal. The second purpose was to evaluate the portal education materials for the top 5 urgent care diagnoses: diabetes, hypertension, asthma, otitis media, and bronchitis for understandability and actionability using the Patient Education Material Assessment Tool, Simple Measures of Goobledygook, and the Up to Date application. The first purpose was framed within the technology acceptance model which used a 26-item Likert scale ranging from -3 (total disagreement) to +3 (total agreement). The staff (n = 8) and patients (n = 75) perceived the portal as useful (62%; 60%), easy to use (72%; 70%), expressed a positive attitude toward using (71%; 73%), and would use the technology (54%; 70%). All materials were deemed understandable (74%-95%) with 70% being the acceptable percentage. Diabetes, otitis media, and bronchitis were deemed actionable (71-100%), but hypertension (57%) and asthma (40%) had lower actionability percentages. Hypertension, asthma, and otitis media had appropriate reading levels (6-8th grade). However, diabetes (10th grade) and bronchitis (12th grade) were higher with the target being less than 8th grade level. All handouts were found to be evidence-based. Recommendations were to revise the diabetes and bronchitis educational handouts to improve readability. Social change can be promoted by this project by facilitating positive patient outcomes at urgent care clinics.

As the bulk of medical health records shift from paper-based file systems to electronic formats, the promise of the transformation process called healthcare reform included adding efficiencies to medical practice workflows, lower costs, improved quality of care and most important, and the freeing of patient information from traditional propriety silos. With this incoming largess of protected health information data now viewable through online patient portals, patients can be empowered to become educated and active in their own health care decisions, but only if they have admission to their information. A digital divide currently exists in many medical practices where only a very few patients have access to their personal health information. The primary goal was to facilitate organizational change needed for physician-managed practices to increase patient adoption and meaningful use of patient portals for secure communication, wellness education, review of labs and other tests, and receipt of clinical summaries. The methodology utilized the appreciative inquiry 4-D model as the underlying basis of three phases: Phase 1-fundamental study, Phase 2-strategic action plan, and Phase 3 supporting organizational change. The physicians or providers in independent medical practices are the key determinate of the organizational workflows. The results have added significantly to the understanding of organizational change as related to patient engagement and the adoption and meaningful use of patient portals in independent physician-managed clinics. As medical practices and their physician leaders raise patient portal workflow processes to a higher level of importance, it is expected that patients will begin to adopt these procedures as their preferred methods and bring about a change in the patient-provider relationship.