This Has Been A While Coming But The Findings Show Once Again What Rubbish Data May Wind Up In The #myHealthRecord!

This appeared a while ago but it matters:

Electronic health records and online medical records: an asset or a liability under current conditions?

Judith Allen-Graham ^{A B G} , Lauren Mitchell ^B , Natalie Heriot ^A , Roksana Armani ^A , David Langton ^{A C} , Michele Levinson ^{A D} , Alan Young ^{A E} , Julian A. Smith ^{A F} , Tom Kotsimbos ^{A B} and John W. Wilson ^{A B}

+ Author Affiliations

Australian Health Review 42(1) 59-65 https://doi.org/10.1071/AH16095
Submitted: 28 April 2016  Accepted: 13 November 2016   Published: 20 January 2017

Journal compilation © AHHA 2018 Open Access CC BY-NC-ND

Abstract:

Objective The aim of the present study was to audit the current use of medical records to determine completeness and concordance with other sources of medical information.

Methods Medical records for 40 patients from each of five Melbourne major metropolitan hospitals were randomly selected (n = 200). A quantitative audit was performed for detailed patient information and medical record keeping, as well as data collection, storage and utilisation. Using each hospital’s current online clinical database, scanned files and paperwork available for each patient audited, the reviewers sourced as much relevant information as possible within a 30-min time allocation from both the record and the discharge summary.

Results Of all medical records audited, 82% contained medical and surgical history, allergy information and patient demographics. All audited discharge summaries lacked at least one of the following: demographics, medication allergies, medical and surgical history, medications and adverse drug event information. Only 49% of records audited showed evidence the discharge summary was sent outside the institution.

Conclusions The quality of medical data captured and information management is variable across hospitals. It is recommended that medical history documentation guidelines and standardised discharge summaries be implemented in Australian healthcare services.

Background:

What is known about this topic? Australia has a complex health system, the government has approved funding to develop a universal online electronic medical record system and is currently trialling this in an opt-out style in the Napean Blue Mountains (NSW) and in Northern Queensland. The system was originally named the personally controlled electronic health record but has since been changed to MyHealth Record (2016). In Victoria, there exists a wide range of electronic health records used to varying degrees, with some hospitals still relying on paper-based records and many using scanned medical records. This causes inefficiencies in the recall of patient information and can potentially lead to incidences of adverse drug events.

What does this paper add? This paper supports the concept of a shared medical record system using 200 audited patient records across five Victorian metropolitan hospitals, comparing the current information systems in place for healthcare practitioners to retrieve data. This research identifies the degree of concordance between these sources of information and in doing so, areas for improvement.

What are the implications for practitioners? Implications of this research are the improvements in the quality, storage and accessibility of medical data in Australian healthcare systems. This is a relevant issue in the current Australian environment where no guidelines exist across the board in medical history documentation or in the distribution of discharge summaries to other healthcare providers (general practitioners, etc).

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Here is the link:

http://www.publish.csiro.au/ah/AH16095

The final two paragraphs of the discussion say it all:

“Lack of concordance between the different information sources means there is no easily identifiable source of truth for healthcare providers. Without comparing individual events, the present study highlights that each database (with the exception of pharmacy at Monash) is separate and is used differently at each of the sites audited. Evaluation of the same index, for example an ADE, between the sources is incredibly difficult and not reliable. For ADEs, this may be in the medical history (paper or scanned), discharge summary, pharmacy database, as a coded event, as a Riskman report or any combination of these. This highlights the exhaustive investigation required by clinicians to locate vital patient information. When analysing data from Riskman, it was apparent that multiple entries were recorded as incidents, many of which were not related to the use of medications. No distinct pattern could be discerned in relation to medication incidents, and descriptors were incomplete in many instances. Reviewers found in some institutions that an incident had been logged in Riskman, but no description of the incident (ADE or other) had been entered in the medical record. It was therefore unclear whether healthcare workers had elected to use an alternative system of reporting or not to report the incident. Riskman has the potential for ADE reporting to be optimised; however, due to the lack of consistency in use across sites, it cannot be used as a baseline measure for any events logged.

Although the health information discordances identified relating to ADEs create the potential for errors, the likelihood of such errors eventuating will largely depend on how specific healthcare providers use each information system, and how they incorporate it into their decision making regarding patient management. A summary healthcare record needs to prioritise major events in a way that helps with patient care decisions in real time. In this setting, an improved focus on the quality of health data capture and the alignment of these data for each patient across the various information systems being used represent an opportunity to both specifically minimise the possibility of ADE errors and, more generally, to improve healthcare efficiencies, effectiveness and, hopefully, patient experiences. How well this is achieved will depend on the quality of local healthcare information capture; at present the paper record interface limits the PCEHR, as does the degree of the current database convergences (e.g. pharmacy and the EHR) and the overall maturity in the EHR. Finally, it is clear that current electronic health systems are simply another tool that used properly can be an excellent asset, but if incorrectly used may be a significant liability.”

Read those paragraphs carefully and you will see just how much error and risk exists in the source systems that are meant to be feeding the myHR. I am sure GP systems will be little better. What this means is that we are sitting on a major fiasco if the records sent to the myHR are treated as anything more than a guess as to what may be going.

I wonder what the boffins at the ADHA and CSIRO are doing about this clear and present danger? Any clinician needs to treat any data from these sources very carefully!

David.