Informing EMR System Design through Investigation of Paper-Based Work Practices in a Non-profit Clinic Serving a Vulnerable Population

We conducted a field study in a non-profit resource-scarce primary care clinic to investigate its current paper-based practices. The goal is to inform the design and deployment of an impending Electronic Medical Record (EMR) system at the clinic. The clinic serves a local vulnerable, low-income population who are insured through local community health plans. We identified problems encountered by the providers in their use of the current paper-based system. We also found that providers customized their work practices so that they can serve the underserved population better. Based on the tacit knowledge that they acquired in the workplace over time, they adapted their patient care to align with the patients´ prescribed health benefits. In this way, the patients were able to receive timely and proper medical care. We also propose technological recommendations for the impending EMR system to address the problems with current practices and to support the adapted practices specifically customized for the low socioeconomic patients.