Quote Of The Year

Quote Of The Year - Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

Sunday, September 24, 2017

An Interesting If Slightly Out Of Date Study That Suggests There Is A Lot Of Work To Do To Show Shared Health Records Are Useful In Urgent Care.

The following was published on September 22, 2017.
The abstract reads:

The role and benefits of accessing primary care patient records during unscheduled care: a systematic review

  • Tom Bowden and
  • Enrico Coiera
BMC Medical Informatics and Decision MakingBMC series – open, inclusive and trusted201717:138
Received: 26 December 2016
Accepted: 8 August 2017
Published: 22 September 2017


The purpose of this study was to assess the impact of accessing primary care records on unscheduled care. Unscheduled care is typically delivered in hospital Emergency Departments. Studies published to December 2014 reporting on primary care record access during unscheduled care were retrieved.
Twenty-two articles met inclusion criteria from a pool of 192. Many shared electronic health records (SEHRs) were large in scale, servicing many millions of patients. Reported utilization rates by clinicians was variable, with rates >20% amongst health management organizations but much lower in nation-scale systems. No study reported on clinical outcomes or patient safety, and no economic studies of SEHR access during unscheduled care were available. Design factors that may affect utilization included consent and access models, SEHR content, and system usability and reliability.
Despite their size and expense, SEHRs designed to support unscheduled care have been poorly evaluated, and it is not possible to draw conclusions about any likely benefits associated with their use. Heterogeneity across the systems and the populations they serve make generalization about system design or performance difficult. None of the reviewed studies used a theoretical model to guide evaluation. Value of Information models may be a useful theoretical approach to design evaluation metrics, facilitating comparison across systems in future studies. Well-designed SEHRs should in principle be capable of improving the efficiency, quality and safety of unscheduled care, but at present the evidence for such benefits is weak, largely because it has not been sought.
The conclusion of the study in detail reads:


Shared electronic records, if well designed and appropriately targeted to meet specific and high value informational needs, should in principle improve the quality, safety and effectiveness of clinical care. At present however, the evidence for such benefits is weak, largely because it has not been sought. Given the scale and cost of such systems, this absence of evidence is both surprising and concerning.
It is also the case that there has been little clarity in connecting the informational needs which arise during unscheduled care with system design and scale. The lack of theoretical models to underpin SEHR design and evaluation means that some of the systems surveyed may not have been fit for purpose [33], but rather were generic technology driven endeavours. Seeing the SEHR as part of an information value chain emphasizes that information delivery must be connected to decision making, for example through decision support systems, to deliver the most value.
The really sad thing about this study is that the closure date for publications probably means that we are still ignorant of any quality studies that have been finalized since mid 2013 (allowing for the publication delay). That is thus really 4 years ago and it is more than possible things have improved, or maybe not - who knows?
Nevertheless there has been time for the studies reported to prove their merit.
I share the concern of the authors that some projects have been running for years, have cost a fortune and have not been yet evaluated. One can only speculate as to why that might be!
I wonder will we get some better evidence from the trials the ADHA is funding which may conclude and be published some time in 2019 as I understand it. Surely we should stop spending until the results are in? Would that speed evidence up?
All in all, in Australia, we are spending billions in a evidence free environment. It must be that the people just was to rush ahead, be paid a salary, spend heaps  and not be at all accountable for your and my money! Or maybe it is just that the ADHA feels trapped in the past and politics and has no will to do better?
What a shambles!


Anonymous said...

You are probably correct about ADHA being trapped, the cream have been dismissed and the department has a new thing to tie another monolithic management structure around. I am sure not a week goes by that the ADHA discovers a new set of hurdles and missing workflows and processes because they through the wrong baby out with the bath water

Bernard Robertson-Dunn said...

The abstract says "... it is not possible to draw conclusions about any likely benefits associated with their use."

But the detailed conclusion says "At present however, the evidence for such benefits is weak, largely because it has not been sought."

This is a rather surprising conclusion. Surely it is possible that "the evidence for such benefits is weak" could be because there are little or no benefits?

An inconsistency at best; I do hope there isn't a degree of confirmation bias going on.

Anonymous said...

Trapped maybe, they still solder on Creating their own digital version of the paper record problem. When your own day to day work existence is founded on monolithic inefficient technologies and processes it is impossible to understand how the rest of the world works.

Anonymous said...

The ACSQHC looked at ED use of the MyHR in 2016 as part of its clinical safety review role. A brief review but does indicate challenges to ED uptake, although positive intent to use if there is greater adoption.


Dr Ian Colclough said...

1:48 PM - "The ACSQHC looked at ED use of the MyHR in 2016 " ...

I find the Methodology Page 3 to be quite meaningless.

The review is purely subjective and of little value, other than to provide some sort mysterious justification for the 'MyHR ED project'.

More so as "No direct observations of patient care were undertaken as part of the review."

Methodology Page 3 says:

The Commission invited these hospitals to participate in the review through workshops or group interviews:
• Toowoomba Base Hospital, Toowoomba, Queensland
• Princess Alexandra Hospital, Brisbane, Queensland
• Royal Hobart Hospital, Hobart, Tasmania
• The Children’s Hospital Westmead, Sydney, New South Wales.

The structured workshops and group interviews were led by Enzyme International, and were supported by Dr Stephen Priestley (an ED physician and member of the Commission’s Clinical Safety Oversight Committee) and Commission officers.

In the workshops and group interviews, common clinical safety and risk themes were identified by participants using an ‘affinity diagram’ method to analyse and prioritise ED clinical safety factors. The analysis used a ‘forced-paired relative importance’ comparison, and assigned priority scores to each factor. A rank–order hierarchy of ED clinical safety factors was calculated for each workshop and group interview, and then consolidated for a view across all participants.

The consolidated view is presented in this report. Approximately 30 ED clinical and management Staff participated in the workshops and group interviews. Participants included a range of public Hospital ED health practitioners, including ED directors, nursing staff, consultants, registrars, residents and primary care liaison clinicians. No direct observations of patient care were undertaken as part of the review.

Anonymous said...

Meaningless, anecdotal evidence. Need to do better.

Anonymous said...

The ADHA is very quiet for some reason. Anyone know why? - Several so called Leaders (undisciplined ladder climbers) are off on world tours, we are not allowed to breath at the moment.