|The Health Record Review
by Jeff Rowe, Editor
Posted on Fri, May 04, 2012 - 11:12 am
From improving population health to making our healthcare system more efficient, a lot is expected from the system-wide implementation of EHRs.
But at least one recent study suggests EHRs could use some improvements in order to live up to those expectations.
Published in January in the Journal of the American Medical Informatics Association, the study examined the accuracy of EHRs when it comes to providing accurate clinical problem lists.
In the introduction to the report, researchers noted that “an accurate and up-to-date patient problem list represents the cornerstone of the problem-oriented medical record, especially in internal medicine. It serves as a valuable tool for providers attempting to familiarize themselves with a patient's clinical status and provides a means of succinctly communicating this information between providers. In addition, an accurate problem list has been associated with higher-quality care.”
Given the importance of accurate patient problem lists, then, the researchers wanted to examine how often, and with what results, providers accepted alerts notifying them of previously unrecorded patient problems. At 28 participating clinics, they “developed an electronic alert . . . which notifies providers when there appears to be an undocumented problem. At the time, a provider saves a typed note or reviews a dictation, and our system analyzes the patient's medications, laboratory results, billing codes, and vital signs and uses the knowledge base to determine whether a patient is likely to have any of the (previously determined) 17 study problems. If the system detects one or more potential problems, it reviews the problem list to determine whether the problem is documented, and, if not, an actionable alert is shown onscreen.”
“We found that electronic problem list alerts were often accepted by users, and resulted in a substantial increase in study problem notation. . . . Overall, study problems were approximately three times more likely to be documented when alerts were shown. This increase is clinically important, since many of these problems are used for quality improvement and CDS.”
They go on to note that “A more complete problem list makes it easier for providers to obtain an accurate picture of a patient's issues, which is especially important when an unfamiliar patient is being seen, such as in the case of urgent care or emergency visits, or in inpatient wards. Additionally, since problems are used for CDS, identification of patients for research studies, and quality measurement, these types of rules show great potential for improving quality and reducing costs.”
Read the full study here.