Electronic health records (EHRs) were originally supposed to make accessing patient data easier and more streamlined, but since they’ve taken off, health workers claim EHRs have only complicated the system. Additionally, EHRs may have even compromised patient care.
The digitization of paper health records was promoted under the American Recovery and Reinvestment Act of 2009. Recently, a University of Michigan study confirmed research about EHRs’ shortcomings, specifically in the outpatient chemotherapy setting.
This is the first known examination of EHRs and their pertinence towards safety in the oncology setting, Christopher Friese, the Elizabeth Tone Hosmer Professor of Nursing and principal investigator on the project, said.
“Chemo is a high-volume, high-risk endeavor and most patients receive these treatments in centers like the ones we studied,” said Friese. “Unlike some other treatments, there’s no reversal, there’s no antidote, we have to get it right the first time. This study tells us that in this complicated space, oncology clinicians tell us that the EHR is posing challenges.”
Friese and his team measured the safety culture and satisfaction within clinic technology and clinician communication among 297 oncology nurses, physicians, and advanced practice providers across 29 oncology practices. All participated in the Michigan Oncology Quality Consortium, a statewide collaborative.
Their results found that clinicians reported lower safety scores in settings with sophisticated EHRs. Additionally, higher satisfaction with technology and better clinician communication was associated with higher safety scores.
When pertaining to patients, this means a couple of things.
“You can’t assume a provider in the same clinic or system has the same information. It’s important for patients and loved ones to keep their own careful notes,” said Friese, who suggested bringing someone along to an appointment to take notes, document test results, and ask questions.
Ultimately, EHR shortcomings posed safety and communication challenges for chemotherapy patients and clinicians, according to lead author Minal Patel, the John G. Searle Assistant Professor of Health Behavior and Health Education.
“The impact that greater use of electronic systems in practices has on patient safety underscores the importance of devoting more attention to strengthening communication between members of the care team,” Patel said.
A few common EHR shortcomings included the fact that doctors, nurses, and pharmacists all receive different patient information rather than one cohesive set of documents. Also, doctors do not always complete notes in real-time, so nurses don’t have up-to-date information on specific patients scheduled for chemotherapy. In addition to empty notes, outdated information is often copied and pasted into patient records, leaving physicians and nurses with information that isn’t pertinent. Lastly, EHRs are hardwired to limit certain functions to select providers, and if the provider isn’t available, it poses numerous problems—especially in smaller clinics.
All of these problems can result in chemotherapy treatment delays and rescheduled appointments.
“But, it’s not all doom and gloom,” Friese said.
Surprisingly, he witnessed some sites with both sophisticated EHRs and high safety scores. Right now, the research team is studying sites with the most and least problems to better perfect EHR practices.