Challenges using electronic health records to support unhealthy alcohol use screening and intervention in primary care practices in the Pacific Northwest.

Objective: Screening Brief Intervention and Referral to Treatment (SBIRT) can reduce the health and social costs associated with unhealthy alcohol use (UAU). Electronic health records (EHRs) can support evidence-based screening practices for UAU and provide performance data needed for quality improvement. The objective of this study was to describe barriers faced by primary care clinics when using EHR systems to support UAU screening and delivery of recommended interventions.

Methods: The Partnerships to Enhance Alcohol Screening, Treatment, and Intervention program (ANTECEDENT) was designed to promote the adoption of SBIRT in primary care clinics through 15 months of tailored practice facilitation. Qualitative data about the participants' experiences were collected through clinic contact logs, periodic reflections, and interviews with practice facilitators and clinic project leads. Data were analyzed through qualitative content analysis to identify and describe the challenges encountered by clinics and facilitators using an 8-domain framework developed to describe socio-technical factors in EHR use.

Results: Forty-eight clinics using 9 different EHRs participated in a tailored practice facilitation. Common EHR-related barriers to SBIRT implementation included an inability to report SBIRT performance data, a lack of reminders for screening, few built-in assessments, cumbersome documentation tasks, workflow variation, limited informatics support, and competing organizational priorities.

Conclusions: Sittig and Singh's framework provided a unique perspective on the challenges primary care clinics participating in ANTECEDENT experienced using a range of EHR systems to support and deliver quality improvements using the SBIRT framework. Our findings were consistent with previous studies evaluating EHR barriers in quality improvement work, and those identified by fellow grantees of the EvidenceNOW: Managing Unhealthy Alcohol Use initiative funded by the Agency for Healthcare Research and Quality. Conclusions: Clinics experience multiple challenges using EHRs to ensure that patients receive needed screening and follow-up for UAU. While vendors may provide relevant capabilities, research is needed to examine what factors affect clinics' awareness, adoption, and use of available EHR features and which are lacking.