Exploring EHR integration with Colorado’s FAMLI system
Colorado Department of Labor and Employment
July 2026 - October 2026
Why This Matters For Families
Over the past 20 years, 14 states and D.C. have adopted paid family and medical leave (PFML) programs that provide income support to families when new children arrive, a family member needs care, or a family breadwinner suffers a personal health issue. Paid leave is associated with higher labor force participation rates, higher earnings over time, better health, worker retention and productivity, and economic growth. To extend those benefits to more Americans, it is essential to pass more state policies and, ideally, a national policy — and ensure those policies are designed and implemented to serve the workers and families who are most in need.
The New Practice Lab team is working directly with state administrators, as well as the individuals and families whom they serve, to streamline state paid leave program benefits. The team has also offered guidance to states working to pass paid family and medical leave laws, offering advice on policy language and processes that will aid benefit delivery to claimants and families. These programs can provide critical relief to U.S. families — but only if they reach the people who need them, when they need them.
Implementation Challenge
Across state paid leave programs, medical certification is a consistent source of delays, friction, and paperwork errors. Making it easier for healthcare providers to submit the information that programs need could help workers complete their applications more quickly and receive benefits sooner, while also saving the state time and freeing up resources for other program functions.
The New Practice Lab helped Minnesota’s paid leave program explore a novel approach to medical certification, incorporating leave certification directly into the electronic health record systems that healthcare providers use. Colorado has committed to implementing a comparable solution, and wants to iteratively improve upon Minnesota’s findings.
Our Approach
The New Practice Lab worked closely with Colorado’s FAMLI team to understand how the state’s medical certification works in practice and use those insights to inform the design of an EHR-integrated solution. We focused particularly on the experiences of healthcare providers and leave takers who face the greatest burdens under the current process.
Building on our previous work in Minnesota and concurrent work in Washington, we:
Interviewed 10 medical providers in Colorado as well as support staff to understand how certification forms move through clinics, where delays and errors occur, and what providers would need and want from an improved FAMLI certification process
Mapped common provider workflows and translated the research into insights that Colorado’s product team can use to design its EHR-integrated certification solution
Connected Colorado with private medical systems in the state interested in serving as early implementation partners as the state develops and rolls out the new approach, providing the state with active, eager collaborators to help scope and stress-test this new solution and make sure it meets a broad set of stakeholders’ needs
Interviewed 11 low-income leave takers about their experiences resolving medical certification problems and conducted usability testing on the Request for Information (RFI) letters applicants receive when additional documentation is needed
Worked with Colorado’s online leave portal team to identify opportunities to prevent certification problems and help applicants resolve them more quickly when they occur
What We Learned
Providers are eager to certify leave inside the tools they already use. The physicians, nurse practitioners, physician assistants, and medical assistants we spoke with agreed, almost without exception, that completing leave certifications within their EHR would be faster, easier, and more convenient. That enthusiasm is the foundation an EHR-integrated pathway is built on.
““An online form would be terrific. [...] I would endorse an EHR process.” ”
An EHR-integrated pathway would move certification from clinic to state in moments rather than days.
Today a signed form often travels by hand, from provider to front desk to patient to the state portal, a journey that can take days or weeks. Delivering certification through the EHR is designed to close that gap, so a completed certification reaches the state as soon as a provider signs off.
Certification inside the EHR would meet providers where they are.
Providers bring different levels of familiarity with paid leave, from specialists who act as informal navigators for patients to primary care teams who field many kinds of certification forms. Delivering certification in the EHR lets the state surface the right guidance at the moment it is needed, whatever a given practice’s prior experience with the program.
““Separately, I don’t think we as providers have had much education about this. Having a provider tip sheet or awareness would be really helpful.” ”
“Usually it’s a patient who says they need FMLA, and that spurs a conversation asking if they need CO FAMLI. Then we explain the differences between FMLA and CO FAMLI (patients get the acronyms confused). Then they look into the eligibility and then help them figure out what to apply for. ”
The approach is designed to make errors easy to fix. On paper, a small clerical mistake, even a missing initial or date, can mean starting a brand new form and waiting on another appointment. An EHR-integrated pathway is designed to let providers correct and resubmit in place, sparing families weeks of delay.
The design accounts for realities beyond the program’s control. Appointment availability across the healthcare system shapes how quickly any certification can begin, and access to care, especially in primary care, affects how soon a patient and provider can connect in the first place. The EHR-integrated approach would make the certification step itself fast and low-friction once they do, so the program adds as little delay as possible on top of existing access realities.
Taken together, these findings point to a future where a step that can take days or weeks could be completed in minutes, during the ordinary course of care. That is the opportunity Colorado is building toward.
Next Steps
Colorado will carry forward this work with light technical assistance from the New Practice Lab. We will continue to learn from Colorado’s implementation and use those lessons, alongside our work in Minnesota and Washington, to inform guidance for other states interested in pursuing similar approaches. EHR-integrated leave certification pathways are a topic of great interest to the broader ecosystem of states with state-based PFML programs, and our role in this work allows us the opportunity to help build shared best practices and implementation considerations from multiple states’ experiences.
