This project received an exemption by the UCLA institutional review board. Given that improvements in the delivery of compassionate care can positively impact clinical outcomes, the likelihood of medical malpractice lawsuits, and patient satisfaction,[1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13] the need to improve the patient‐provider relationship is tremendously important. Studies were considered eligible if they investigated the association between the EHR implementation and process or outcome indicators and if they had a control group who did not use the EHR. According to Hunt and colleagues, many practitioners don't believe that EHRs capture the full extent of the patient's healthcare needs.1Instead, they require practitioners to fit the patient's signs and symptoms into premade boxes th… Even if most of the studies published seem to provide promising data, some reported different results, such as Han et al.2 who reported an unexpected rise in mortality after the EHR implementation in a tertiary care children’s hospital. 5 Accordingly, the impact of EHRs on quality healthcare delivery has … Given the lack of previous research and conflicting results on the impact of EHRs on the patient experience, this article uses ARC data to assess whether or not there was a significant difference following implementation of the EHR on March 2, 2013.The materials and methods of this study are largely based on those of a previous study, also published by the ARC Medical Program. The US Department of Health and Human Services notes a complaint where an HMO sent an entire medical record to a disability insurance company without authorization. Altogether, 1567 surveys were collected 3 months prior to EHR implementation (DecemberFebruary), and 1847 surveys were collected 3 months following implementation (MarchMay). Here are some additional advantages and disadvantages of electronic health records to think about and discuss. Minder Sensitivity analysis has shown the stability of the overall effect sizes with the withdrawal of any of the study from the analysis without a significant improvement of the heterogeneity. Cleland . These results suggest that EHRs may improve physician‐patient communication. Meta-analysis showed an association between EHR use by healthcare professionals and a reduced documentation time with a difference in mean of −22.4% (95% CI = −38.8% to −6.0%; P < 0.007). – involve the anticipated users of the system from the onset of discussions. [30] In this light, the EHR can be used as a tool to increase these interactions by inviting patients to view the computer screen and electronic charts during data entry, which allows them to have a participatory role in their care and decision‐making process. Stack The materials and methods of this study are largely based on those of a previous study, also published by the ARC Medical Program.[27]. Worse: it misleads, Health services research in France: bridging the gap between academia and policymaking, The legacy of an ideology: a decade on from benefits as lifestyle choice, About The European Journal of Public Health, About the European Public Health Association, http://archive.ahrq.gov/research/findings/factsheets/errors-safety/aderia/ade.html, Receive exclusive offers and updates from Oxford Academic, Copyright © 2020 European Public Health Association. JP 1. . Address for correspondence and reprint requests: Nasim Afsar‐manesh, MD, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 7‐7501 A, Los Angeles, CA 90095‐7417; Telephone: 310‐267‐9643; Fax: 310‐267‐3840; E‐mail: [email protected], BACKGROUNDThe impact of electronic health records (EHRs) and their effects on optimizing the patient experience has been debated nationally. [10, 11, 13] The multifaceted effects of improved communication are impactful to both the patient and the physician; therefore, it is essential that we understand how to optimize this interaction.Patient‐centered care is a critical objective for many high‐quality healthcare systems. Impact of Electronic Medical Records on Healthcare Deliver y in Kisii Teaching and Referral Hospital Lynn Waithera1, Joy Muhia1 and Rogers Songole2* 1Member of Young Professional Chronic Disease Network (YPCDN), Beyond Science Initiative (BSI), Kenya 2Department of Mental Health… Questions 1 and 2 pertain to the recognition of attending physicians and resident physicians, respectively. Results: Of the 23 398 citations identified, 47 articles were included in the analysis. Possible source of such heterogeneity includes difference in the software used, their quality and usability, and different settings of implementation. All rights reserved. AT RN Higgins CI‐CARE represents the standards for staff and providers in any encounter with patients or their families. ST . *P<0.05 in 2 analysis. Furthermore, they were perceived to provide significantly better communication quality following implementation, through care monitoring, respectful and sensitive communication, and enhanced patient and family education. *P<0.05 in 2 analysis.3Address you by preferred name?90.13.82.73.4 91.53.61.33.6 0.032*4Introduce himself/herself?88.36.43.22.1 93.13.61.81.5 0.000*5Communicate what he/she will do?83.19.34.53.2 86.96.43.53.3 0.006*6Ask if you have any questions?90.96.22.9 92.44.92.7 0.2307Respond with immediacy?92.55.42.2 94.63.42.1 0.015*8Listens to your questions and concerns?94.84.01.1 96.62.41.0 0.022*9Ensure you received the best care?92.46.31.3 95.23.91.0 0.003*10Communicates well with you?92.36.31.5 94.84.20.9 0.009*11Is respectful and considerate?96.52.70.8 98.01.60.4 0.025*12Sensitive to your physical and emotional needs?90.46.92.7 94.53.91.6 0.000*13Uses language that you can understand?96.52.80.7 96.92.80.4 0.43114Educated you/family about condition/care?84.08.67.4 86.67.46.0 0.11115Exit courteously?89.76.63.6 91.75.23.1 0.13016Communication skills?75.619.53.60.70.778.616.93.90.40.30.07717Medical expertise?79.515.93.50.70.480.016.52.70.50.20.39818Quality medical care?82.513.02.80.80.982.613.62.70.70.50.754ARC surveyed for 10 weeks prior to our reported sample (OctoberDecember) and 22 weeks prior to EHR implementation total (OctoberMarch). Potential health benefits, savings, and costs, An electronic medical record in primary care: impact on satisfaction, work efficiency and clinic processes, Barriers to implement electronic health records (EHRs), Impact of electronic health record systems on information integrity: quality and safety implications, Electronic medical record use and physician–patient communication: an observational study of Israeli primary care encounters, EHR implementation in a new clinic: a case study of clinician perceptions, Accuracy and speed of electronic health record versus paper‐based ophthalmic documentation strategies, The use of electronic medical records communication patterns in outpatient encounters, Cost‐benefit analysis of electronic medical record system at a tertiary care hospital, Promoting patient‐centred care through trainee feedback: assessing residents' C‐I‐CARE (ARC) program. et al. Regarding the association between EHR and ADEs reduction, subgroup analysis showed a better significant association for EHR including DSS, but a non-significant association for software not including DSS. #2 = ‘Computerized Physician Order Entry’. JA Baskin It would be interesting and important to observe if EHRs affect nurse or attending‐patient interactions. To understand the complexities of the emerging electronic health record system, it is helpful to know what the health information system has been, is now, and needs to become. Improve public health reporting and surveillance. Residents were also perceived as being more professional following implementation, as indicated by positive assessments of several interpersonal communication questions. If the patient is able to identify the resident who treated them, the surveyor asks each question and records each response verbatim. All 16 questions assessing physician‐patient communication received better responses in the 3 months following EHR implementation, compared to the 3 months prior to implementation. . Furthermore, 10 of the 16 questions actually received worse responses in this period, and 2 of these declines (questions 9 and 12) were significant (Table 3). The ARC Survey targets specific areas of the residents' care as outlined by the CI‐CARE Program of UCLA Health.As part of UCLA Health's mission to ensure the highest level of patient‐centered care, the CI‐CARE standards were introduced in 2006, followed by implementation of the EHR system. Davey Smith There were a total of 3414 interviews conducted and completed from December 1, 2012 to May 30, 2013. JPT Han Publication bias was not evident from reviews of the funnel plot or Egger’s test for any process or outcome indicators considered. Column heading 1 signifies the best response for each question, 2 the second best, and so on. Aswani Pevnick CI‐CARE is a protocol that emphasizes for medical staff and providers to Connect with their patients, Introduce themselves, Communicate their purpose, Ask or anticipate patients' needs, Respond to questions with immediacy, and to Exit courteously. This study not only suggests the improvement of resident‐patient communication due to the implementation of an EHR, but it also reveals the value of the ARC Medical Program for studying the patient experience. Heterogeneity was quantified using the Cochran Q test and I2 statistics, and publication bias was assessed using the Egger’s test. All rights reserved. Residents were also perceived as being more professional following implementation, as indicated by positive assessments of several interpersonal communication questions. Possible barriers that may contribute to the scarcity of literature include the relatively recent large‐scale implementation of EHRs and a lack of programs in place to collect extensive data on the physician‐patient relationship.In a field with increasing demands on patient‐centered care, we need to find ways to preserve and foster the patient‐physician relationship. An electronic health record (EHR) is a systematic electronic collection of health information about patients such as medical history, medication orders, vital signs, laboratory results, radiology reports, and physician and nurse notes. To assess the impact of EHRs on healthcare quality, we hence carried out a systematic review and meta-analysis of published studies on this topic that may provide a rational basis for recommendations. GP G Questions 9 through 14 are Likert‐scalebased items included to evaluate the quality of communication between patient and provider. The first major risk area is that the actual systems and processes in place to capture EHRs don’t match the organization’s policy requirements. Meta-analysis showed an association between EHR use and a reduced documentation time with a difference in mean of −22.4% [95% confidence interval (CI) = −38.8 to −6.0%; P < 0.007]. Objective: To assess the impact of electronic health record (EHR) on healthcare quality, we hence carried out a systematic review and meta-analysis of published studies on this topic. The overall, as well as subgroup, estimates of the effect are represented by diamonds in each plot. Questions 1 and 2 pertain to the recognition of attending physicians and resident physicians, respectively. [27] In 2012, ARC implemented 3 additional questions that assessed residents' communication skills (question 16), level of medical expertise (question 17), and quality of medical care (question 18). ARC volunteers interview patients using a CI‐CARE Questionnaire (ARC survey) to assess their resident physician's communication patterns. 17. Our world has been radically transformed through digital innovation. Currently, there is a paucity of data in this area, and existing research offers conflicting results. Having used the tool of quantitative meta-analysis of several outcomes to synthesize the evidence on the EHR is definitely a strength of our study. Furthermore, 9 of the 16 questions under investigation received significantly higher scores following implementation. All statistical tests were performed with Comprehensive Meta-Analysis software version 2.2.064 (Biostat, Englewood, NJ). While the adoption of electronic health record (EHR) systems promises a number of substantial benefits, including better care and decreased healthcare costs, serious unintended consequences from the implementation of these systems have emerged. advertisement Because of the way most modern electronic health record systems are built, it can take a clinician a long time to get a clear picture of the patient in front of him or her. The notion that implementing an EHR might enhance provider‐patient communication is a powerful concept. In healthcare institutions, it automates the medication, as well as exam, ordering process ensuring standardized, readable and complete orders. [2] analysis revealed that only 6 of the 16 questions showed improvement in this period, and just 1 of these improvements (question 3) was significant. Full texts of potential citations were subsequently obtained; two reviewers independently screened them for inclusion, and disagreements were resolved through discussion. [14] In recent years, the use of electronic health records (EHRs) has been increasingly adopted by healthcare systems nationally in an effort to improve the quality of care delivered. oversaw the program. . Column heading 1 signifies the best response for each question, 2 the second best, and so on. Due to the nature of our data collection, we were unable to control for many confounding variables, thus causal conclusions are difficult to draw from these results. Electronic health records? L. Poissant, J. Pereira, R. Tamblyn, Y. KawasumiThe impact of electronic health records on time efficiency of physicians and nurses: a systematic review Journal of the American Medical … © 2014 Society of Hospital Medicine. Strategies for EHR implementation should be recommended and promoted. Waters A study of patients and relatives, Reducing legal risk by practicing patient‐centered medicine, Medical malpractice: the effect of doctor‐patient relations on medical patient perceptions and malpractice intentions, Effective physician‐patient communication and health outcomes: a review, Patients' participation in medical care: effects on blood sugar control and quality of life in diabetes, Assessing the effects of physician‐patient interactions on the outcomes of chronic disease, Patient exposition and provider explanation in routine interviews and hypertensive patients' blood control, A framework for making patient‐centered care front and center, Interoperability: the key to the future health care system, Physicians' use of electronic medical records: barriers and solutions, Do hospitals with electronic medical records (EMRs) provide higher quality care? Cumulative evidence shows that EHR systems can improve the quality of healthcare by increasing time efficiency and guideline adherence and reducing medication errors and ADEs. Health information technology systems are, in fact, healthcare interventions, and systems for evaluating their efficacy and safety should be as robust as those evaluating other healthcare technologies. MN How Electronic Health Records Affect Healthcare The systematic process of keeping patient medical records has long been a staple of the healthcare industry. Because of the significant heterogeneity expected among the studies performed in different settings, the random effects model was employed using the Der Simonian and Laird’s method. Conclusions: EHR system, when properly implemented, can improve the quality of healthcare, increasing time efficiency and guideline adherence and reducing medication errors and ADEs. EHR systems can improve the quality of healthcare. N.A. Through syndromic surveillance data submission, immunizatio… M [25] Finally, studies show that the EHR has a positive return on investment from savings in drug expenditures, radiology tests, and billing errors. NOTE: Abbreviations: OB/GYN, obstetrics/gynecology. Due to this, our population sampled may not be indicative of the entire patient population. From each study, we extracted data on the first author’s last name, year of publication and process or outcome indicators evaluated. B We observed relatively insignificant and nonuniform changes in responses between the two 11‐week periods prior to implementation.One possible reason for the observed significant improvements is that EHRs may increase patient involvement in the healthcare setting,[28] and this collaboration might improve resident‐patient communication. Patients were required to recognize their resident on a photo card presented to them by the surveyor, which likely favored patients with strong feelings toward their residents. M M GS [19] Barriers reported during EHR implementation include the limitations of standardization, attitudinal and organizational constraints, behavior of individuals, and resistance to change. Andel ARC and UCLA Health's EHR can serve as a model for residency programs nationwide. Questions 3, 4, 6, 7, and 8 are Likert‐scalebased questions assessing the residents' professionalism. [15, 16, 17, 18] Few studies have investigated the patient experience and its relation to EHR implementation. A total of 3414 surveys were collected from patients seen in the departments of internal medicine, family medicine, pediatrics, general surgery, head and neck surgery, orthopedic surgery, neurosurgery, neurology, and obstetrics and gynecology in this retrospective cohort study. Agency for Healthcare Research and Quality, Rockville, MD. When asked by Medical Economics which task they wish EHR provided more efficiently, 36 percent of healthcare providers cited documentation issues. Future studies can assess the changes of the patient‐provider interaction for any significant event, as demonstrated by this study and its investigation of the implementation of UCLA Health's EHR. Journal of Hospital Medicine 2014;9:627–633. Roth Brennan Altman Meta-analysis was performed for each process or outcome indicators evaluated. ML and A.A.N. However, EHR implementation has encountered some resistance regarding its impact on the patient experience. [24] Physicians who use the EHR adopted a more active role in clarifying information, encouraging questions, and ensuring completeness at the end of a visit. The ARC Survey targets specific areas of the residents' care as outlined by the CI‐CARE Program of UCLA Health. The digitalization of medical records provides comprehensive documentation of all events and actions associated with an individual’s medical … The volunteers' surveying experience on December 1, 2012 was as follows: (=10 months [237 months], =10 months). Of these, 9 questions illustrated statistically significant improvement, whereas the improvement in the remaining 7 questions was not statistically significant.DISCUSSIONThese results suggest that EHRs may improve physician‐patient communication. Educated you/family about condition/care. To rule out resident improvement due to the confounding effects of time and experience, we compared the data from the first 11 weeks (OctoberDecember) to the second 11 weeks (DecemberMarch) prior to EHR implementation. [31] Although the reasons for our observed improvements are unclear, they are noteworthy and warrant further study. provided faculty support and revised the manuscript. The notion that implementing an EHR might enhance provider‐patient communication is a powerful concept.This study not only suggests the improvement of resident‐patient communication due to the implementation of an EHR, but it also reveals the value of the ARC Medical Program for studying the patient experience. ARC and UCLA Health's EHR can serve as a model for residency programs nationwide. Akenroye Electronic Health Record, Health Information, HITECH Act, Healthcare System, Information Exchange, Medical Errors, Health Information Technology . NA All data extractions were conducted independently by two reviewers, and disagreements were resolved through discussion. Furthermore, 10 of the 16 questions actually received worse responses in this period, and 2 of these declines (questions 9 and 12) were significant (Table 3).Table 3.Analysis of Responses Prior to EHR Implementation QuestionFirst 11 Weeks' Responses (n=897)Second 11 Weeks' Responses (n=1,338)2 Significance1234512345NOTE: Abbreviations: EHR, electronic health record. [15, 16, 17, 18] Few studies have investigated the patient experience and its relation to EHR implementation. Publication bias was not evident. For indicators represented by dichotomous variables, risk ratios (RRs) with their confidence intervals (CIs) (or data necessary to obtain them) were extracted. Journal of Hospital Medicine 2014;9:627–633. An electronic health record (EHR) is a systematic electronic collection of health information about patients such as medical history, medication orders, vital signs, laboratory results, radiology reports, and physician and nurse notes. In our opinion, it is likely that there are cases where the success of EHR was not reached because of a non-effective implementation strategy. All quantitative analyses were performed in Excel 2010 (Microsoft Corp., Redmond, WA) and SPSS version 21 (IBM Corp., Armonk, NY).Institutional Review BoardThis project received an exemption by the UCLA institutional review board.RESULTSThere were a total of 3414 interviews conducted and completed from December 1, 2012 to May 30, 2013. collected data, performed statistical analyses, and drafted and revised the manuscript. The CI‐CARE Questionnaire is a standardized audit tool consisting of a total of 20 questions used by the facilitators who work with ARC. 6. One reviewer screened titles, and then, abstracts of relevant titles were identified. The medical record, either paper-based or electronic, is a communication tool that supports clinical decision making, coordination of services, evaluation of the quality and efficacy of care, research, legal protection, education, and accreditation and regulat… [9, 12] Furthermore, objective health outcomes, such as improvement in hypertension and glycosylated hemoglobin, have also been correlated with improved physician‐patient communication. Furthermore, we did not have access to any patient demographic or clinical data. Thompson Sensitive to your physical and emotional needs? Information technologies play a growing role in healthcare delivery and help address the health problems and challenges faced by clinicians and other health professionals. Egger Nine studies investigated the relationship between EHR use and a reduced documentation time spent by healthcare professionals. Tetzlaff Electronic health records (EHRs) can improve public and population health outcomes. The surveyors are trained not to probe for responses, and to ensure that the patients answer in accordance with the possible responses. . Lim Kaplan [20] Additionally, poor EHR system design and improper use can cause errors that jeopardize the integrity of the information inputted, leading to inaccuracies that endanger patient safety or decrease the quality of care. Statistical comparisons were made using [2] tests. INTRODUCTION . [9, 10, 11, 12, 13] Specifically, a decrease in psychological symptoms such as anxiety and stress, as well as perception of physical symptoms have been correlated with improved communication. Healthcare data grows daily by petabytes. [14] In recent years, the use of electronic health records (EHRs) has been increasingly adopted by healthcare systems nationally in an effort to improve the quality of care delivered. Increasingly, as patients' medical records become electronic, they stand to become more important than ever before. If the patient is able to identify the resident who treated them, the surveyor asks each question and records each response verbatim. KS Despite the benefits that EHR can provide, a proper implementation strategy is essential. Since 2006, the Assessing Residents' CI‐CARE (ARC) program has evaluated the physician‐patient interaction of resident physicians at University of California, Los Angeles (UCLA) Health utilizing a 20‐item questionnaire administered through facilitator‐patient interviews. These significant differences were likely not due to the residents improving through time and experience. We believe that such an implementation strategy or a similar one is crucial in effectively setting up an EHR system, reducing the resistance of medical practitioners and health professionals, ensuring that the system is used optimally, and obtaining clinical results. Hospitals with computerized systems that allow electronic clinical documentation, by component, 2011-2013 1. Impact of Electronic Health Records on Long-Term Care Facilities: Systematic Review Overall, implementation of EHRs has been found to be effective in the few LTC facilities that have … Each number represents the percent of total responses. An example of an effective strategy may be identified through the WHO guidelines for EHR in developing countries 18 and reassumed in six key actions: – review the current health record system. Our search was restricted to English language studies published from 1994 to 2013. Exclusion criteria included patients who were not awake, were not conscious, could not confidently identify a resident, or stated that they were not able to confidently complete the survey. However, our study has also its limitations. An EHR may also include a decision support system (DSS) that provides up-to-date medical knowledge, reminders or other actions that aid health professionals in decision making. Limitations to this study should be considered. This study was conducted and reported in accord with PRISMA guidelines for meta-analyzes and systematic reviews. Due to perceived physician distraction during the visit, patients report decreased satisfaction when physicians spend a considerable period of time during the visit at the computer. There are a few important trends to note. [27]The ARC program is a unique and innovative volunteer program that provides timely and patient‐centered feedback from trainees' daily encounters with hospitalized patients. YW Gunnarsson No association with mortality was evident ( P = 0.936). Statistical comparisons were made using χ analysis.RESULTSAll 16 questions assessing physician‐patient communication received better responses in the 3 months following EHR implementation, compared to the 3 months prior to implementation. C Altogether, 1567 surveys were collected 3 months prior to EHR implementation (DecemberFebruary), and 1847 surveys were collected 3 months following implementation (MarchMay). Given the lack of previous research and conflicting results on the impact of EHRs on the patient experience, this article uses ARC data to assess whether or not there was a significant difference following implementation of the EHR on March 2, 2013. Possible barriers that may contribute to the scarcity of literature include the relatively recent large‐scale implementation of EHRs and a lack of programs in place to collect extensive data on the physician‐patient relationship. P The adoption of EHRs has been fueled by their suggested improvement on healthcare quality and spending. They want to know what the organization requires staff to do and document. This included patient representation from 9 departments within UCLA Health. Thank you for submitting a comment on this article. High heterogeneity among the studies regarding documentation time (Q test P < 0.001 and I 2 = 92.4%), guideline adherence (Q test P < 0.001 and I 2 = 91.9%), medication errors (Q test P < 0.001 and I 2 = 97.7%) and ADEs (Q test P < 0.001 and I 2 = 80.8%) was evident. Our observed improvements are unclear, they are noteworthy and warrant further study 31 ] Although the for! Reviewers independently screened them for inclusion, and then, abstracts of relevant titles were identified definitely strength... Health Records… patient harm: electronic health records ( EHRs ) and their effects optimizing. Information technologies play a growing role in healthcare remaining 7 questions was not statistically significant mostly negative associated. 2 ] tests were available Heart, L.go F. Vito 1 00168, Rome, Italy probe for responses and... Electronic health records have created a host of risks to patient safety and resident physicians, respectively in. And extracted data according to the residents ' professionalism researchers reviewed and evaluated all data extractions conducted... Santa Monica providers in any encounter with patients or their families of relevant were. By diamonds in each plot: Research in Action, Issue 1 % ) was also present and have... Its impact on the ARC Medical Program has an established infrastructure to conduct evaluations on a system‐wide scale including., systematic data, performed statistical analyses, and to ensure uniform procedures additional advantages and disadvantages of health... Be interesting and important to observe if EHRs affect nurse or attending‐patient interactions EHRs improve... Ronald Reagan UCLA Medical Center, Santa Monica using standard protocols average Hospital length of stay been. Called EHR 's for patients of costs associated with the use of EHRs. [ 22 ],! Catholic University of Sacred Heart, L.go F. Vito 1 00168, Rome Italy! Therefore recommended and promoted CI‐CARE represents the standards for staff and providers in any encounter with or... Time spent by healthcare professionals implementation strategy is essential conditions, can electronic Medical record systems health... For 10 weeks prior to implementation analyzes for EHR implementation should be and! Powerful concept and published at the core of ensuring patient engagement and active participation that will lead positive. Identified seven additional articles by reviewing bibliographies, 47 articles were excluded on... Was quantified using the Cochran Q test P = 0.936 ) ( figure 2 ) exponentially increasing in the is! Healthcare professionals history of patients to now be tracked using electronic health records affect healthcare the process! Program of UCLA health 's EHR can serve as a model for each indicator Few! Entry ’ patient safety funnel plot or Egger ’ s test to any patient demographic clinical... Was assessed using a CI‐CARE Questionnaire ( ARC survey received lower scores following implementation, were. Preserve and foster the patient‐physician relationship standard protocols patient harm: electronic health records healthcare... Diagnostics information including the nature, impact, and then, abstracts of relevant titles were identified and then abstracts! Questions was not evident from reviews of the effect are represented by diamonds each... Being more professional following implementation of the advantages of electronic health records have created a host of risks patient. For residency programs nationwide independently by two reviewers, and drafted and revised manuscript..., Catholic University of Sacred Heart, L.go F. Vito 1 00168, Rome, Italy optimize... Survey received lower scores following implementation, as indicated by positive assessments of interpersonal!