Success Factors of an Early EHR System for Lessons Learned for Future Practice Data-Driven Decision Aids Kaban Koochakpour a , Øystein Nytrø a , Odd Sverre Westbye b,c , Bennett Leventhal d , Roman Koposov e,f , Victoria Bakken b , Carolyn Clausen b , Thomas Brox Røst a , Norbert Skokauskas b a Department of Computer Science, The Norwegian University of Science and Technology, Trondheim, Norway b Regional Centre for Child and Youth Mental Health and Child Welfare, Central Norway, Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway c Department of Child and Adolescent Psychiatry, St. Olav's University Hospital, Trondheim, Norway d Department of Psychiatry, Division of Child and Adolescent Psychiatry, The Univ. of California San Francisco, CA, United States e Regional Centre for Child and Youth Mental Health and Child Welfare, Northern Norway,UiT The Arctic University of Norway, Tromsø, Norway f Sechenov First Moscow State Medical University, Moscow, Russia Abstract This paper recounts the successful BUPdata, a discontinued electronic health record (EHR) system for Child and Adoles- cent Mental Health Services (CAMHS) in Norway. It was de- veloped and owned by the national association for CAMHS and fulfilled needs for collaborative care, practice insight, and ser- vice management. It aimed to unify the requirements of govern- ment, administration, clinicians, patients, and researchers alike, with the goal of providing uniform quality of care nation- ally. When CAMHS became integrated with specialist healthcare, BUPdata was replaced with more a general EHR system offering far less functionality and insight into CAMHS practice. We have studied BUPdata, and interviewed stake- holders in order to develop decision aids based on practice data analysis and give clinicians and patients insight into successful local practice, collaboration patterns, and overview of local re- sources. Keywords: Electronic Health Record, Clinical Decision Support Systems, Child and Adolescent Mental Health Services. Introduction Child and Adolescent Mental Health Services (CAMHS) in Norway are organized as separate clincal units, with a high de- gree of autonomy, and independent from both primary and other specialist health services. A long and strong tradition of multidisciplinary collaboration with social services, educa- tional psychological services, schools, patient organizations, and both patients and parents was changed after a major reform of public health services in 2004 when CAMHS and other men- tal health services were integrated into regional health trusts. Electronic Health Record (EHR) systems have been in use in Norwegian healthcare for more than 35 years. First gaining widespread acceptance in general practice and CAMHS, some years later in hospitals and remaining municipal health services. Even with public healthcare funding, IT in healthcare was not centrally organized, and a multitude of EHR systems are still operational. CAMHS had to adopt hospital EHRs in order to streamline diagnosis-related payment models, quality control, and production reporting. This paper presents the history of the EHR, BUPdata, that served CAMHS in place around Norway until 2019. We re- count the features and functions that made this EHR a success in order to lay the foundation for the development of a novel, and domain-specific, knowledge aid and clinical decision sup- port system (DSS). The findings are based on both, the study of software artifacts, as well as interviews held with system de- signers, managers, secretaries, data users, and other stakehold- ers. The objective of this study is to develop guidelines and re- quirements for the IDDEAS [9] project, which aims to develop CAMHS-specific decision aids integrated in general EHR sys- tems [8,10]. Background In 1984, the Norwegian Association for Child and Adolescent Psychiatric Institutions (NFBUI) decided on having a common information system to support clinical work and foster quality in clinical practice. At that time, EHR systems were replacing paper records in Norway, and NFBUI prescient leaders decided that they needed a tool to support the multi-faceted and uniquely collaborative work environment in CAMHS. The first such systems were deployed in 1986. One point of discussion was whether the system should support data collection for research and management, or for day-to-day clinical work. As a result, developers concluded that information models should include details required for research needs, while user interfaces would be designed primarily to support clinicians. By 1990 NFBUI would become both the owner and the developer of a full-fledged EHR system, BUPdata, including its deployment and provision of support, as well as its user-training for almost all CAMHS across the country. One main reason for the successful adoption of BUPdata was that local administrative personnel and secretaries were active in NFBUI and responsible for introduction of the system training and user-training. Other early design decisions were to record and code family history, as well as collaborative care, and to use a multidimensional classification, allowing clinicians to represent the state, condition, and progress of patient care. BUPdata started as a tool for outpatient clinics, and only later became important for inpatient logistics. A company, HIADATA AS, was funded by early developers to provide EHRs for collaborating services and to commercialize BUPdata [1]. Child and Adolescent Mental Health: MEDINFO 2021: One World, One Health – Global Partnership for Digital Innovation P. Otero et al. (Eds.) © 2022 International Medical Informatics Association (IMIA) and IOS Press. This article is published online with Open Access by IOS Press and distributed under the terms of the Creative Commons Attribution Non-Commercial License 4.0 (CC BY-NC 4.0). doi:10.3233/SHTI220057 182