Patient records: Electronic or electric, you decide?
The use of Electronic Patient Records (EPRs) is now an accepted part of modern medicine, as many now recognise that using EPRs is safer and more productive than using paper.
EPRs or Electronic Medical Records (EMRs), as they are known outside of the UK, are frequently associated with improved simultaneous access, improved legibility, and, most importantly, improved patient safety, especially in areas such as clinical decision support, prescribing and computerised order entry - using the EPR to request blood tests, imaging examinations, and therapy assessments.
EPRs come in all shapes and sizes and range from the wall-to-wall "one size fits all" monolith approach, to the best of breed/ best of suite to the "home brew" in-house development approach, particularly popular in Spain.
The approach is often defined by the hospital’s historical investment, the availability of resources - now and in the future, the views and preferences of clinicians, and the ability of the CIO to influence the chief executive and the members of the senior management team. One would hope that whatever the approach looks like, it has come, as a result, of detailed analyses which has thoroughly examined all the pros/ cons and benefits to both clinician and patient.
Data collected by HIMSS Analytics from over 800 European hospitals (excluding Turkey) tell us that 22 per cent of EPRs are provided as wall to wall "one size fits all" (80 per cent or more applications from the same vendor), 23 per cent of EPR systems are best of breed (less than 50 per cent of applications from the same vendor), 42 per cent are best of suite (when 50 to 79 per cent of applications are from the same vendor), and 13 per cent of EPR systems are in-house developments (50 per cent or more of applications are self-developed).
Whilst choice of system and the degree of variability in approach is interesting, even unusual, given that most acute care hospitals are all providing healthcare in very much the same way, EPRs all have one thing in common - they all contain structured data fields that "do things".
Hospitals invest in IT but see no additional value or benefit from a patient safety or quality of clinical care perspective
The clue is in the "E", the "E" being an abbreviation for Electronic. If the EPR system collects the height and weight of the patient the system should be able to calculate the patient’s Body Mass Index (BMI). If the BMI is collected, the doctor can be assisted by a "weight based dosing" algorithm, which, together with the patients date of birth, may prevent the doctor from prescribing an adult dose of a drug to a child or help the doctor by ensuring that the dose of the drug is in accordance with the patients BMI. If the EPR is capturing laboratory results the doctor can be assisted to prescribe the appropriate dose of an anti-coagulant because the system is able to recognise the latest INR result.
EPR systems can also assist members of the nursing team to provide nursing tasks that are commensurate and aligned with different levels of risk. For example, should a falls risk assessment determine that the patient is at high risk of falling, the care plan is automatically populated with nursing interventions that are only associated with this level of risk. This goes some way to ensure that care is standardised and reduces the possibility of low risk interventions being offered when the risk of falling is high.
To be clear, scanned paper, electronic forms, systems that contain large amounts of unstructured data or 100 per cent free text with no alerts, no warnings, and no clinical decision support are not EPR systems. The abbreviated "E" in this case probably stands for Electric.
Sadly, we see hospitals that have invested significantly in information technology, more systems than sense, multiple clinical data stores, little connectivity, robots in all the right places, but no additional value or benefit from a patient safety or quality of clinical care perspective.
So, if you are a Chief Information Officer or a Chief Clinical Information officer reading this, make yourself a note to review all the data fields within your clinical application(s) to make sure that first of all those clinical data fields are capable of receiving structured data and then that those data fields actually do something to help clinicians. If your EPR is helping clinicians with clinical decision support, well calibrated alerts and warnings your EPR is likely to be electronic, if not, it’s an electric record.
Finally, if you have persuaded the Chief Executive and members of the Senior Management Team to invest in scanning facilities and an Electronic Document Management system as an alternative to an EPR system, you may be at some point be asked to explain why.