The overall goal of this Medication Monitoring for Vulnerable Populations via IT proposal is to demonstrate the ability of health information interoperable exchange and electronic health records (EHR) to provide useful quality and safety measures for the vulnerable populations served by the Baltimore Medical System (BMS) Community Health Center (CHC). These efforts and analyses will serve as models for maximizing the utility of information technology in ambulatory settings among patients at high risk for substandard care. This project's goal will be accomplished by a practice-based demonstration of the capacity to generate useful quality and safety measures by linking electronic health records, laboratory data, and claims data for vulnerable populations served by a community health center. The quality and safety measures we will evaluate were recently developed by the National Committee for Quality Assurance, supported by the National Quality Forum for ambulatory care, and focus on the safety monitoring for chronic medications that are commonly used by patients with heart disease and diabetes mellitus. While these measures focus on the process of obtaining annual safety monitoring for patients on these medications, there is a lack of national guidelines or consensus on how providers are to respond to these monitoring tests. This gap may be critical in ensuring that these proposed process measures actually link to differences in patient outcomes, which is the central tenet supporting the use and monitoring of such processes. We will assess the usefulness of Information Technology (IT)-derived versions of these quality and safety measures based on a National Quality Forum framework of being accurate compared to gold standard data, useful and actionable to clinicians, and linked to impact on patient outcomes. To achieve this we will deploy EHR-based measures, perform chart reviews, provide feedback to clinicians, and survey clinicians. Since the implementation of health IT involves organizational culture and workflow change as well as technology, we will also evaluate the association between successful deployment of health IT and organizational culture. To achieve this we will utilize the validated Safety Attitudes Questionnaire which has recently been further validated for use in ambulatory settings. [unreadable] [unreadable] [unreadable] [unreadable]