Tuesday, November 22, 2016
A Team From The US Identify A Really Key Issue In EHR Use. Food For Really Deep Thought I Reckon.
This paper was released a little while ago:
D. F. Sittig (1), A. Wright (2), J. Ash (3), H. Singh (4, 5)
(1) University of Texas Health Science Center at Houston, School of Biomedical Informatics and UT-Memorial Hermann Center for Health Care Quality and Safety, Houston, TX, USA; (2) Harvard Medical School and Brigham and Women’s Hospital, Department of Medicine, Boston, MA, USA; (3) Oregon Health & Science University, Department of Medical Informatics and Clinical Epidemiology, Portland, OR, USA; (4) Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; (5) Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
Medical Informatics, Confidentiality, Data Display, usability, Quality indicators, Electronic Health Records (EHRs)
Although the health information technology industry has made considerable progress in the design, development, implementation, and use of electronic health records (EHRs), the lofty expectations of the early pioneers have not been met. In 2006, the Provider Order Entry Team at Oregon Health & Science University described a set of unintended adverse consequences (UACs), or unpredictable, emergent problems associated with computer-based provider order entry implementation, use, and maintenance. Many of these originally identified UACs have not been completely addressed or alleviated, some have evolved over time, and some new ones have emerged as EHRs became more widely available. The rapid increase in the adoption of EHRs, coupled with the changes in the types and attitudes of clinical users, has led to several new UACs, specifically: complete clinical information unavailable at the point of care; lack of innovations to improve system usability leading to frustrating user experiences; inadvertent disclosure of large amounts of patient-specific information; increased focus on computer-based quality measurement negatively affecting clinical workflows and patient-provider interactions; information overload from marginally useful computer-generated data; and a decline in the development and use of internally-developed EHRs. While each of these new UACs poses significant challenges to EHR developers and users alike, they also offer many opportunities. The challenge for clinical informatics researchers is to continue to refine our current systems while exploring new methods of overcoming these challenges and developing innovations to improve EHR interoperability, usability, security, functionality, clinical quality measurement, and information summarization and display.
Here is another presentation of the same issue from the same team:
The slow, but steady, move from fee-for service to pay-for-performance payment models in health care has given rise to more EHR-based clinical quality measurement. This push for quality measurement has necessitated an increased need for capturing complete, accurate, structured data that can easily be extracted, aggregated, and reported to administrators, quality oversight organizations (e.g., University Health Consortium), and payers – both public and private. The need to capture structured data items such as “smoking status” , “pain scores” , venous thromboembolism prophylaxis, and documentation of the need for patient restraints every 24 hours has led to many convoluted clinical documentation workflows . These new workflows are not only changing the way clinicians perform their work, but they are potentially interfering with their diagnostic and therapeutic critical thinking tasks leading to serious, preventable, adverse events , as well as having a negative impact on patient-provider interactions at the point of care .
New Unintended Adverse Consequences of Electronic Health Records
D. F. Sittig, A. Wright, J. Ash, H. Singh University of Texas Health Science Center at Houston, Year book Med Inform 2016:7-12 http://dx.doi.org/10.15265/IY-2016-023
Published online November 10, 2016
Here is a link:
The essential core of what is being said is here:
“These new workflows are not only changing the way clinicians perform their work, but they are potentially interfering with their diagnostic and therapeutic critical thinking tasks leading to serious, preventable, adverse events , as well as having a negative impact on patient-provider interactions at the point of care.”
What I am reading here is that moving EHR use away from the absolute basics to support care to be doing other things in parallel can harm both the quality and safety of care as well as the patient experience of their care.
This is a very powerful idea which we need to be confident we are taking careful note of. Distracting the care focussed work flow (as with maybe the myHR) may have severe (and dangerous) un-intended consequences. I look forward to ADHA analysing the material here and making some sensible responses to mitigate the apparent risks.
Posted by Dr David More MB PhD FACHI at Tuesday, November 22, 2016