Term of Award

Spring 2016

Degree Name

Doctor of Public Health in Public Health Leadership (Dr.P.H.)

Document Type and Release Option

Dissertation (open access)

Copyright Statement / License for Reuse

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


Jiann-Ping Hsu College of Public Health

Committee Chair

Gulzar Shah

Committee Member 1

Robert Vogel

Committee Member 2

Jeff Jones


Background: Electronic Health Record (EHR) implementation has seen great advances in health care, but the movement is leaving public health agencies behind. EHRs have shown improvement in operational and societal outcomes when implemented. Scarce allocation of resources, lack of trained staff, and security are limiters to implementation, despite the varied benefits of EHRs. The objective of this research is to establish a comprehensive view of EHR implementation in local health departments (LHDs) through assessing the status of implementation, benefits, barriers, and strategies to overcome challenges. Methods: This research uses a mixed methods approach to assess 49 key-informant interviews and 324 web-based surveys from leaders and primary users of informatics within LHDs. These data assist in the evaluation of current practices, capabilities, and needs of LHDs. The qualitative interviews are coded by themes and sub-themes using NVivo software. Using SPSS and SAS analytical software, survey logistic regression and descriptive statistics the quantitative data were analyzed. Results: The majority of the LHDs do not have EHR implementation activity and are using non-EHR systems for data storage. Approximately 42 percent of LHDs implemented a type of EHR system. The most frequently mentioned benefits of EHR implementation are care coordination, retrieval or managing information, track outcomes of care, increased efficiencies, and accurate records. However, the barriers are costs or financial resources, resistance to change, no clinical services, lack of training, and low priority. LHD characteristics individually, significantly associated with the implementation of EHRs at least at the 0.05 significance level are: hardware allocation and acquisition within a central department in the LHD, hardware allocation and acquisition at county or city IT department, type of internet, and organizational activities related to informatics within the LHDs. For LHDs who have not implemented EHR systems, almost half have selected a system and are in the process of implementation. Conclusion: Despite the barriers of costs and resistance to change of EHR implementation in LHDs, the leaders are optimistic about the future of EHRs in LHDs even making plans for future implementation. Successful implementation is influenced by the level of control of informatics and organizational activities related to informatics.