Validations
A standardized validation process was performed at the regional level, which involved a clinical applications coordinator (CAC) from each location. The CAC is a technician who supports local software integration. During the validation process, the CAC was asked to create a small set of test PCCs and patients (simulating real data presented in EHR). All algorithms and ETL processes were tested by the research staff. Testing included identifying test PCCs and patients from EHR data, documenting eligibility and consent based on assigned status, and detecting approval orders when digital signatures were provided. These steps were necessary to ensure the electronic workflows were compatible with regional practices.The Boston Healthcare System was the first primary care network to implement these electronic workflows. Changes were anticipated with the inclusion of other regional networks. Accordingly, the EHR integrations were assembled using a modular design to minimize programming effort during system modification. Database updates also were expected. This entailed data format changes and other modifications to the data structure. The research staff had limited control over these changes that were implemented by the EHR system developers. A series of quality control measures were needed to identify unpredictable changes.