Community Health Center Adoption of Enabling Technologies to Address Contextual Drivers of Health for Care-Managed Patients: Formative Evaluation

Abstract Background Care management programs are increasingly exploring new strategies to address contextual drivers—social needs that influence health, such as food, housing, and transportation—among high-risk patients. Electronic health record (EHR)–based care management tools can support efforts to manage patients’ contextual drivers through screening and making referrals to address identified needs. However, knowledge is limited on how to promote adoption and use of these “enabling technologies” by care managers in community-based health centers (CHCs). Objective To examine how care management staff in CHCs currently use EHR tools, including an integrated module developed to support care management, to address patients’ contextual drivers. Results will inform the development of implementation strategies targeting adoption of such tools. These strategies will be piloted, refined, and then tested in a randomized trial. Design Formative evaluation informed by human-centered design principles. Participants Care management staff ( n = 11) and subject matter experts ( n = 5) from a multi-state network of health centers. Approach Semi-structured interviews were conducted, followed by a rapid qualitative analytic approach to explore contextual factors, barriers, and implementation strategies for using EHR tools to coordinate care involving addressing contextual drivers of health among care-managed patients. Key Results Some EHR features (e.g., screening flowsheets, alerts) are used for screening documentation. Challenges to using the care management module for care coordination related to contextual drivers include limitations inherent to the EHR tools (e.g., no discrete fields for referral documentation) and insufficient training on referral-making and follow-up. Participants emphasized the need for leadership support, hands-on training, and care plan customization to align with health center services and care management reimbursement requirements. Conclusions Obstacles hinder the effective use of EHR care management tools for care coordination involving addressing contextual drivers of health. Targeted implementation support may help remove these barriers.