Here Is A Review I Seem To Have Missed On EHR’s and Emergency Departments.

I came across this during the week:

Implementation Method and Clinical Benefits of Using National Electronic Health Records in Australian Emergency Departments: Literature review and environmental scan for the My Health Record in Emergency Departments project

Downloads

Implementation Method and Clinical Benefits of Using National Electronic Health Records in Australian Emergency Departments: Literature review and environmental scan for the My Health Record in Emergency Departments project

Download File - 793 KB

We aim to provide documents in an accessible format. If you're having problems using a document with your accessibility tools, please contact us for help.

Here is the link:

https://www.safetyandquality.gov.au/publications-and-resources/resource-library/implementation-method-and-clinical-benefits-using-national-electronic-health-records-australian-emergency-departments-literature-review-and-environmental-scan-my-health-record-emergency-departments-project

Here is the executive summary.

Executive Summary

This literature review provides background information to inform the implementation and use of the My Health Record in Australian emergency departments (EDs). The My Health Record is considered a national Electronic Health Record (EHR) system. EHRs are a summary of a consumer’s health information that is sourced from a variety of healthcare providers. These providers can include general practitioners (GP), hospitals, specialists, and community pharmacists. EHRs are different to an Electronic Medical Record (EMR), with the latter being a system internal to a healthcare organisation, such as a hospital, and is only accessible by healthcare providers. The findings from this literature review seek to address two principle research questions:

·         What are the benefits of using EHRs in hospital EDs?

·         What barriers and enablers affect the routine use of EHRs by clinicians in hospital EDs?

The report provides:

·         An overview of the current status of My Health Record implementation, including within EDs

·         An overview of national EHR implementations in the UK, Denmark, Austria and Canada, describing key EHR features, implementation approaches and application to emergency care settings

·         Literature findings in relation to the implementation of EHR in ED, including the demonstrated benefits, and the barriers and enablers for implementation.

Benefits are examined in relation to the domains of safety, quality, effectiveness of care, and efficiency. They are also examined from the point of view of patients, clinicians and organisations.

Barriers and enablers are identified at various levels, including in relation to:

·         The attributes of the overall My Health Record system

·         The content and interoperability of the record

·         Clinician-related factors

·         Patient-related factors

·         Organisational factors.

There is a gap within the peer-reviewed literature regarding EHR patient-outcome measures. Many experts in the field suggest this reflects the absence of scientific frameworks in which EHR systems are implemented, although there are examples of some states and territories embracing a systematic approach to demonstrate the clinical value of their EHRs.

Limited information was found in the grey literature to demonstrate the benefits of EHR use in emergency care, although the anticipated benefits are well documented in various high- level strategies and plans for implementation.

The environmental scan demonstrated that international health jurisdictions varied in their EHR implementation. Consumer-centred access control featured prominently in EHRs of developed countries, highlighting that privacy remains a universal concern. EHR content focuses on patient demographics, treatment history, medications, allergies, and recent tests, mainly pathology and diagnostic imaging.

Table 1: Summary of barriers, benefits and patient outcomes of EHR use in ED

Domain	Barriers	Benefits	Patient Outcomes
Patient safety	·   Poor training and awareness17 ·   Poor system interface between EHR and EMR13	·   Access to critical information in an emergency situation40, 100 ·   Reduced duplication of diagnostic imaging62 ·   Reduced duplication of pathology8	·   Reduced inappropriate admissions12,40 ·   Reduced adverse drug reactions44 ·   Reduced radiation exposure62
Quality of care	·   Lack of trust with content87 ·   Poor accessibility24	·   Improved and timely access to information for complex patients with multiple comorbidities8 ·   Improved decision- making12	·   More appropriate care12
Efficiency	·   Poor integration with workflows95 ·   Poor useability and navigation of content9	·   Improved workflow11, 42 ·   Improved sourcing and documenting of a patient’s history54	·   Improved communication9
Effectiveness	·   Lack of content88	·   Improved treatment plans13, 15	·   Reduced readmissions9, 12, 15

In terms of barriers and enablers, studies100, 103 have shown that ED clinicians’ interactions with an EHR system are motivated by the availability of summary information, and by accessibility through integration with ‘in-house’ clinical information systems (CISs). Research has noted clinicians find this particularly useful for mostly complex patients with comorbidities.12 Previous encounters, dispensed medications, pathology, and imaging results are closely associated with an ED clinician’s decision to admit or discharge a patient.15 Hospitalisations and readmissions are less likely if an ED clinician uses an EHR during their examination and treatment.12

The usability of EHRs within the ED setting is dependent on components of the EHR user interface, such as system functionality, document display, and access to content.13 The adoption of EHR systems by ED clinicians is impeded by poor functionality and lack of integration with existing ED workflows.49 This is exacerbated during busy periods, which are common in the time-poor environment of an ED.103 Clinicians have a low tolerance of access delays to EHR content, generally being prepared to wait no more than three seconds.87

EHR use by ED clinicians, on a regular basis as part of routine clinical tasks, is positively associated with high rates of patient registration and clinical content.17 EHR implementation should be supported with training, no less than two weeks prior to ‘go-live’.43 Investment in suitable infrastructure can provide assurance to clinicians regarding dependability and speed of access.96 Lessons learnt from the international literature indicate adaptive changes must receive the same due diligence as technical changes. 50 The former point highlights the fact that users should be supported in adjustments to their work processes, which will assist in embedding and optimising routine EHR use.

----- End Text.

Here is the conclusion:

Conclusion

EHR systems have the potential to assist clinical decision-making, which in turn leads to the delivery of high-quality patient care. An EHR enables expeditious retrieval of supplementary health information, which is particularly vital in a time-critical environment such as the ED, and can reduce reliance on information from patients and carers.

The literature highlights a number of barriers regarding uptake of EHR in ED that are repeated across emergency care settings, irrespective of size and patient demographics. The literature indicates that EHRs can improve patient safety, particularly by reducing adverse drug reactions and unnecessary duplication of diagnostic imaging. Improvements in patient care are influenced by the involvement of clinicians in determining how EHR routine use is integrated with ED workflows.

Despite the literature demonstrating benefits on ED workflows, EHR systems have not been embraced by clinicians, who are seemingly averse to any change that prolongs patient treatment time. Adoption is inhibited by entrenched ED clinical practices of treating a patient’s immediate symptoms. Implementation teams should acknowledge the detrimental impact on time and clinician productivity that EHRs are likely to have in the short term. The recovery and improvement of clinician productivity, compared to baseline levels, has been widely documented and should be leveraged as a motivator for routine use.

The literature supports the notion that training and awareness should accompany any EHR implementation. Equal consideration should be allocated to factors that prepare clinicians for organisational change. Senior ED clinicians, of all clinical professions, should lead EHR incorporation into workflows and clinical processes. ED clinicians typically source additional clinical information via conventional methods such as fax and phone. An EHR system would substitute this existing process and reduce time taken for patient history gathering.

Clinicians should further develop their understanding of when and how to meaningfully use EHR content, in order to maximise safety and quality of care. The literature indicates that EHR content can produce a greater yield for patients with higher complexities, which in turn can improve patient examination thoroughness and clinical treatment.

EHR system governance can provide assurance to clinicians and develop trust. Data quality assurance and standards for entering information into an EHR can improve information exchange in a structured format.9 The interpretation and application of EHR content enables improved discernment regarding closely matched differential diagnoses. ED clinicians are motivated to adopt and routinely use an EHR when best-use cases are demonstrated.

The literature remains mixed on valid measures of EHR use, as well as post-implementation optimisation of the EHR system. Nonetheless, the opportunities to improve patient care via the application of EHR content to clinical practice are universally acknowledged.

Government organisations are investing in EHR implementations across international health jurisdictions, even in the absence of robust benefit realisation frameworks. Only when EHR outcomes research catches up with implementation will routine clinician use be accomplished.

----- End Conclusion.

Despite its age there is very useful information in this report especially in what not to do. Sadly the myHR does many of these like having old or information free records and not clearly signaling when useful content is available.

At the end of the day the myHR is unlike any other EHR system (incomplete, multi-document and of unknown age) and so no real conclusions can actually be drawn.

Interesting report but hardly a basis for putting myHR’s in ED’s

David.