BMJ  2003;326:1439-1443 (28 June), doi:10.1136/bmj.326.7404.1439

Information in practice

The electronic patient record in primary care—regression or progression? A cross sectional study

Julia Hippisley-Cox, senior lecturer in general practice1, Mike Pringle, professor in general practice1, Ruth Cater, researcher1, Alison Wynn, researcher1, Vicky Hammersley, Trent Focus Research Network coordinator1, Carol Coupland, senior lecturer in medical statistics1, Rhydian Hapgood, MRC training fellow in health service research2, Peter Horsfield, clinical director, PRIMIS1, Sheila Teasdale, service director, PRIMIS1, Christine Johnson, lecturer in general practice1

1 Division of General Practice, Nottingham University, Nottingham NG7 2RD, 2 Sheffield Centre for Integrated Genetics, Section of Public Health, ScHARR, University of Sheffield, Sheffield S1 4DA

Correspondence to: J Hippisley-Cox julia.hippisley-cox{at}nottingham.ac.uk

Objectives To determine whether paperless medical records contained less information than paper based medical records and whether that information was harder to retrieve.

Design Cross sectional study with review of medical records and interviews with general practitioners.

Setting 25 general practices in Trent region.

Participants 53 British general practitioners (25 using paperless records and 28 using paper based records) who each provided records of 10 consultations.

Main outcome measures Content of a sample of records and doctor recall of consultations for which paperless or paper based records had been made.

Results Compared with paper based records, more paperless records were fully understandable (89.2% v 69.9%, P=0.0001) and fully legible (100% v 64.3%, P < 0.0001). Paperless records were significantly more likely to have at least one diagnosis recorded (48.2% v 33.2%, P=0.05), to record that advice had been given (23.7% vs 10.7%, P=0.017), and, when a referral had been made, were more likely to contain details of the specialty (77.4% v 59.5%, P=0.03). When a prescription had been issued, paperless records were more likely to specify the drug dose (86.6% v 66.2%, P=0.005). Paperless records contained significantly more words, abbreviations, and symbols (P < 0.01 for all). At doctor interview, there was no difference between the groups for the proportion of patients or consultations that could be recalled. Doctors using paperless records were able to recall more advice given to patients (38.6% v 26.8%, P=0.03).

Conclusion We found no evidence to support our hypotheses that paperless records would be truncated and contain more local abbreviations; and that the absence of writing would decrease subsequent recall. Conversely we found that the paperless records compared favourably with manual records.


Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to StumbleUpon StumbleUpon   Add to Technorati Technorati    What's this?

Relevant Articles

Patients should have to opt out of national electronic care records: FOR
Nigel Watson and John D Halamka
BMJ 2006 333: 39-42. [Full Text] [PDF]

Risk of adverse gastrointestinal outcomes in patients taking cyclo-oxygenase-2 inhibitors or conventional non-steroidal anti-inflammatory drugs: population based nested case-control analysis
Julia Hippisley-Cox, Carol Coupland, and Richard Logan
BMJ 2005 331: 1310-1316. [Abstract] [Full Text] [PDF]

Effect of combinations of drugs on all cause mortality in patients with ischaemic heart disease: nested case-control analysis
Julia Hippisley-Cox and Carol Coupland
BMJ 2005 330: 1059-1063. [Abstract] [Full Text] [PDF]

Electronic patient records in primary care: Study has serious flaw
N T Shaw
BMJ 2003 327: 622. [Extract] [Full Text]

Paperless records are better than traditional system
BMJ 2003 326: 0. [Full Text]

This article has been cited by other articles:

  • Calvert, M. J, Shankar, A., McManus, R. J, Ryan, R., Freemantle, N. (2009). Evaluation of the management of heart failure in primary care. Fam Pract 26: 145-153 [Abstract] [Full text]  
  • Chen, C., Garrido, T., Chock, D., Okawa, G., Liang, L. (2009). The Kaiser Permanente Electronic Health Record: Transforming And Streamlining Modalities Of Care. Health Aff (Millwood) 28: 323-333 [Abstract] [Full text]  
  • Pascoe, S. W, Neal, R. D, Heywood, P. L, Allgar, V. L, Miles, J. N., Stefoski-Mikeljevic, J. (2008). Identifying patients with a cancer diagnosis using general practice medical records and Cancer Registry data. Fam Pract 25: 215-220 [Abstract] [Full text]  
  • Tamblyn, R., Huang, A., Taylor, L., Kawasumi, Y., Bartlett, G., Grad, R., Jacques, A., Dawes, M., Abrahamowicz, M., Perreault, R., Winslade, N., Poissant, L., Pinsonneault, A. (2008). A Randomized Trial of the Effectiveness of On-demand versus Computer-triggered Drug Decision Support in Primary Care. J. Am. Med. Inform. Assoc. 15: 430-438 [Abstract] [Full text]  
  • Tsai, J., Bond, G. (2008). A comparison of electronic records to paper records in mental health centers. Int J Qual Health Care 20: 136-143 [Abstract] [Full text]  
  • Hippisley-Cox, J., Parker, C., Coupland, C., Vinogradova, Y. (2007). Inequalities in the primary care of patients with coronary heart disease and serious mental health problems: a cross-sectional study. Heart 93: 1256-1262 [Abstract] [Full text]  
  • McGrath, J. M., Arar, N. H., Pugh, J. A. (2007). The influence of electronic medical record usage on nonverbal communication in the medical interview. Health Informatics Journal 13: 105-118 [Abstract]  
  • Calvert, M. J, McManus, R. J, Freemantle, N. (2007). The management of people with type 2 diabetes with hypoglycaemic agents in primary care: retrospective cohort study. Fam Pract 24: 224-229 [Abstract] [Full text]  
  • George, J., McCaig, D. J, Bond, C. M, Cunningham, I. S., Diack, H L., Watson, A. M, Stewart, D. C (2006). Supplementary Prescribing: Early Experiences of Pharmacists in Great Britain. The Annals of Pharmacotherapy 40: 1843-1850 [Abstract] [Full text]  
  • Watson, N., Halamka, J. D (2006). Patients should have to opt out of national electronic care records: FOR.. BMJ 333: 39-42 [Full text]  
  • Hippisley-Cox, J, Coupland, C (2006). Effect of statins on the mortality of patients with ischaemic heart disease: population based cohort study with nested case-control analysis. Heart 92: 752-758 [Abstract] [Full text]  
  • Schers, H., van den Hoogen, H., Grol, R., van den Bosch, W. (2006). Continuity of care through medical records--an explorative study on GPs' management considerations. Fam Pract 23: 349-352 [Abstract] [Full text]  
  • Ventres, W., Kooienga, S., Vuckovic, N., Marlin, R., Nygren, P., Stewart, V. (2006). Physicians, Patients, and the Electronic Health Record: An Ethnographic Analysis. Ann Fam Med 4: 124-131 [Abstract] [Full text]  
  • Hippisley-Cox, J., Coupland, C., Logan, R. (2005). Risk of adverse gastrointestinal outcomes in patients taking cyclo-oxygenase-2 inhibitors or conventional non-steroidal anti-inflammatory drugs: population based nested case-control analysis. BMJ 331: 1310-1316 [Abstract] [Full text]  
  • Hamilton, W, Peters, T J, Round, A, Sharp, D (2005). What are the clinical features of lung cancer before the diagnosis is made? A population based case-control study. Thorax 60: 1059-1065 [Abstract] [Full text]  
  • Clark, A M, Findlay, I N, for the Have a Heart Paisley IT Group, (2005). Improving evidence based cardiac care and policy implementation over the patient journey: the potential of coronary heart disease registers. Heart 91: 1127-1130 [Abstract] [Full text]  
  • Hippisley-Cox, J., Coupland, C. (2005). Effect of combinations of drugs on all cause mortality in patients with ischaemic heart disease: nested case-control analysis. BMJ 330: 1059-1063 [Abstract] [Full text]  
  • Hippisley-Cox, J., O'Hanlon, S., Coupland, C. (2004). Association of deprivation, ethnicity, and sex with quality indicators for diabetes: population based survey of 53 000 patients in primary care. BMJ 329: 1267-1269 [Abstract] [Full text]  
  • Embi, P. J., Yackel, T. R., Logan, J. R., Bowen, J. L., Cooney, T. G., Gorman, P. N. (2004). Impacts of Computerized Physician Documentation in a Teaching Hospital: Perceptions of Faculty and Resident Physicians. J. Am. Med. Inform. Assoc. 11: 300-309 [Abstract] [Full text]  
  • Shaw, N T (2003). Electronic patient records in primary care: Study has serious flaw. BMJ 327: 622-622 [Full text]  

Rapid Responses:

Read all Rapid Responses

Downtime?
Robert D Swallow
bmj.com, 29 Jun 2003 [Full text]
Paperless and Organised
Nandalal J Gunaratne
bmj.com, 3 Jul 2003 [Full text]
The National Programme for IT
Rino Coladangelo, et al.
bmj.com, 3 Jul 2003 [Full text]
always another way...
Adrian K Midgley
bmj.com, 3 Jul 2003 [Full text]
Serious Flaw
Nicola T Shaw
bmj.com, 3 Jul 2003 [Full text]
Politically correct?
P Millares Martin
bmj.com, 4 Jul 2003 [Full text]
Access jobs at BMJ Careers
Whats new online at Student BMJ