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Methods Inf Med. 2019 Jun;58(1):1-8. doi: 10.1055/s-0039-1692464. Epub 2019 Jul 5.

Translating Research into Agile Development (TRIAD): Development of Electronic Health Record Tools for Primary Care Settings.

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Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, United States.
Indiana University School of Informatics and Computing, Indianapolis, Indiana, United States.
Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon, United States.
Department Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, United States.



 This article describes a method for developing electronic health record (EHR) tools for use in primary care settings.


 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.


 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.


 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.


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