Electronic health records (EHR) were adopted nationwide as part of the U.S. Affordable Care Act (ACA), as well as the ongoing push to digitize paper across and throughout the health system value chain.   Claims emerged that since their inception, EHR may have also contributed to the compromising of patient care.  University of Michigan set to investigate this topic in more detail.

The Study

This was the first known examination of EHRs and safety in an oncology setting.  The investigative team measured safety, culture and satisfaction with clinic technology and clinician communication among 297 oncology nurses, physicians and advanced practice providers across 29 oncology practices participating in the Michigan Quality Consortium, a statewide collaborative network.

The team uncovered that clinicians reported lower safety scores with the most sophisticated EHRs. High satisfaction with specific technology and better clinician communication was associated with higher safety scores.

As reported in the University of Michigan’s news release, common EHR challenge areas emerged:

  • Doctors, nurses and pharmacists receiving different patient information
  • Doctors not completing notes in real-time, leaving nurses without up-to-date information on patients scheduled for chemotherapy
  • Outdated information copied and pasted into patient records
  • EHRs are hardwired to limit certain functions to select providers.  If that provider isn’t available, it represents challenges, particularly in smaller clinics

These EHR issues can result in chemotherapy treatment delays, which often trigger a ripple effect as patients often drive from afar only to wait, or worse, reschedule appointments. The researchers found some sites were EHRs scored high.  They pose intriguing questions for further research and inquiry.

Moving Forward

EHRs are three tier applications including a database, application server and web interface layer. They are often designed around generalized practice areas and their designers often place a big emphasis on billing. The seamless, cross-functional health-institution collaboration and communication tools are still in need, for the most part, of improvement.  Improved support to help clinicians integrate technology and facilitate communication may be of considerable help.  Moreover cancer care is an important and unique practice area.  It is perhaps the case that specific EHR workflows—including collaboration and communication—need to be tailored and purpose-configured for oncology practices.

Study Sponsor

The study was funded by the Agency for Health Care Research Quality, under grant #R01-HS024914. It was published in Journal of Oncology Practice.

Lead Research/Investigators

Christopher Friese 

Source: University of Michigan

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