Taking an action research approach, we engaged in fieldwork with school-based behavioral health care teams to: observe record keeping practices, design and deploy a prototype system addressing key challenges, and reflect on its use. We describe the challenges of capturing behavioral data using both paper and electronic records. Creating records of behaviors requires direct observation, and as a result the record keeping responsibility is challenging to distribute across a care team. Behavioral data on paper must be transferred and prepared for reporting, both inside the organization and to stakeholders outside of the organization. In prototyping a computerized working record, we targeted user needs for capturing details of a behavioral incident in the moment. Challenges persisted through the transition from paper to our prototype, and based on these empirical findings over two years of fieldwork, we present five tensions in representing behavioral data in an electronic health record. These tensions reflect the differences between entering behavioral data into the record for intraorganizational use versus interorganizational use.

我们采取行动研究方法，与校本行为医疗保健团队进行实地考察，以：观察记录保存实践，设计和部署解决关键挑战的原型系统，并反思其使用。我们描述了使用纸质和电子记录捕获行为数据的挑战。创建行为记录需要直接观察，因此记录保存责任很难在整个护理团队中分配。纸上的行为数据必须在组织内部和组织外部的利益相关者之间传输并准备报告。在对计算机化工作记录进行原型设计时，我们针对用户需要捕捉当下行为事件的详细信息。从纸到原型的过渡过程中仍然存在挑战，基于两年的实地工作的实证结果，我们提出了在电子健康记录中表示行为数据的五个紧张关系。这些紧张关系反​​映了将行为数据输入记录以供组织内部使用与组织间使用之间的差异。