Abstract
Objectives This article describes a method for developing electronic health record (EHR) tools
for use in primary care settings.
Methods The “Translating Research into Agile Development” (TRIAD) method relies on the close
collaboration of researchers, end users, and development teams. This five-step method
for designing a tailored EHR tool includes (1) assessment, observation, and documentation;
(2) structured engagement for collaboration and iterative data collection; (3) data
distillation; (4) developmental feedback from clinical team members on high-priority
EHR needs and input on design prototypes and EHR functionality; and (5) agile scrum
sprint cycles for prototype development.
Results The TRIAD method was used to modify an existing EHR for behavioral health clinicians
(BHCs) embedded with primary care teams, called the BH e-Suite. The structured engagement
processes stimulated discussions on how best to automate BHC screening tools and provide
goal tracking functionality over time. Data distillation procedures rendered technical
documents, with information on workflow steps, tasks, and associated challenges. In
the developmental feedback phase, BHCs gave input on screening assessments, scoring
needs, and other functionality to inform prototype feature development. Six 2-week
sprint cycles were conducted to address three domains of prototype development: assessment
and documentation needs, information retrieval, and monitoring and tracking. The BH
e-Suite tool resulted with eight new EHR features to accommodate BHCs' needs.
Conclusion The TRIAD method can be used to develop EHR functionality to address the evolving
needs of health professionals in primary care and other settings. The BH e-Suite was
developed through TRIAD and was found to be acceptable, easy to use, and improved
care delivery during pilot testing. The BH e-Suite was later adopted by OCHIN Inc.,
which provided the tool to its 640 community health centers. This suggests that the
TRIAD method is a promising research and development approach.
Keywords
clinical informatics - human factors and ergonomics - agile scrum software development
methodology - electronic health record systems
