Abstract
Background: The electronic health record (EHR) has opened a new era for health services research (HSR) where information technology (IT) is used to re-engineer care processes. While the EHR provides one means of advancing novel solutions, a promising strategy is to develop tools (e.g., online questionnaires, visual display tools, decision support) distinct from, but which interact with, the EHR. Development of such software tools outside the EHR offers an advantage in flexibility, sophistication, and ultimately in portability to other settings. However, institutional IT departments have an imperative to protect patient data and to standardize IT processes to ensure system-level security and support traditional business needs. Such imperatives usually present formidable process barriers to testing novel software solutions. We describe how, in collaboration with our IT department, we are creating an environment and a process that allows for routine and rapid testing of novel software solutions. Methods: We convened a working group consisting of IT and research personnel with expertise in information security, database design/management, web design, EHR programming, and health services research. The working group was tasked with developing a research IT environment to accomplish two objectives: 1. maintain network/ data security and regulatory compliance; 2. allow researchers working with external vendors to rapidly prototype and, in a clinical setting, test web-based tools. Results: Two parallel solutions, one focused on hardware, the second on oversight and management, were developed. First, we concluded that three separate, staged development environments were required to allow external vendor access for testing software and for transitioning software to be used in a clinic. In parallel, the extant oversight process for approving/managing access to internal/external personnel had to be altered to reflect the scope and scale of discrete research projects, as opposed to an enterpriselevel approach to IT management. Conclusions: Innovation in health services software development requires a flexible, scalable IT environment adapted to the unique objectives of a HSR software development model. In our experience, implementing the hardware solution is less challenging than the cultural change required to implement such a model and the modifications to administrative and oversight processes to sustain an environment for rapid product development and testing.