The importance of patient involvement in the implementation of EHR
Dear Editor,
For the last few years, health providers have invested more attention to achieve meaningful use of electronic health record (EHR) , and less concern has been devoted to review issues on patient safety to improve the quality of care.[1] In their research paper, Barnett et al [2] argue that there is no general correlation between EHR implementation and short-term inpatient mortality, adverse safety events, or readmissions in 17 hospitals in the United States.[2] Regardless of consideration that EHR implementation might unfavorably influence patient treatment during the acute transition time, the authors mentioned that the study results could be justified to ensure its utilization for doctors and hospitals.[2]
However, the study did not involve patients and did not have the intention to announce the findings to the relevant patient community [2], giving the impression that patient interest is rather neglected than the medical outcome in the service delivery setting. One rationale for this is clinicians or researchers often focusing more on the outcome of treatment in defining patient safety, which is different from patients’ perspective that focus more on the process and interpersonal relation.[3]
In my opinion, patients involvement hold the pivotal role in patient safety scheme since they can participate in monitoring and reporting errors and adverse events.[4] Several studies have found the positive association between patient experience and perception of care, and the general indicators of safety and quality in the hospitals. [5,6] Other studies found that greater overall satisfaction level of the patient is associated with lower 30-days risk of hospital readmission [7] and patient’s engagement in their own treatment, such as asking queries or participating in decision-making, is correlated with adverse event reduction.[8]
A national survey in 2007 in the United States found that clinicians often have a tendency not to report an adverse event to authorities.[9] This condition leads to unreported adverse events or errors that could not be captured in the medical record.[9] Many of the previous EHR improvement has focused on collecting objective information, such as medication lists and laboratory results. Less attention has been dedicated to more comprehensive task that could capture patient’s concerns and preferences.[10] EHR could be used as a standardized instrument in carrying out clinical protocols and other procedures to reduce clinical carelessness and other adverse events.[10] For those reasons above, the development of EHR in the clinical setting should incorporate patient involvement.[10]
Despite Barnett et al [2] has identified that the implementation of EHR is not correlating with the serious adverse event in the short term, the technology should be utilized to do more than accessing health data. EHR should also analyze data from various sources and serves as an instrument to simplify action.[11] In term of patient safety, patients should be involved in the design of EHR so the technology could reach its optimal potential.
References:
1. Singh H, Sittig DF. Measuring and improving patient safety through health information technology: The Health IT Safety Framework. BMJ Quality & Safety. 2016;25(4):226-32. doi:10.1136/bmjqs-2015-004486
2. Barnett ML, Mehrotra A, Jena AB. Adverse inpatient outcomes during the transition to a new electronic health record system: observational study. BMJ.2016;354. doi:10.1136/bmj.i.3835.
3. Rathert C, Brandt J, Williams ES. Putting the ‘patient’ in patient safety: a qualitative study of consumer experiences. Health Expectations. 2012;15(3):327-36. doi:10.1111/j.1369-7625.2011.00685.x
4. Rathert C, Huddleston N, Pak Y. Acute care patients discuss the patient role in patient safety. Health care management review. 2011;36(2):134-44.
5. Isaac T, Zaslavsky AM, Cleary PD, Landon BE. The relationship between patients' perception of care and measures of hospital quality and safety. Health Services Research. 2010 2010/08//:1024+. doi: 10.1111/j.1475-6773.2010.01122.x
6. Jha AK, Orav EJ, Zheng J, Epstein AM. Patients' Perception of Hospital Care in the United States. New England Journal of Medicine. 2008;359(18):1921-31. doi: 10.1056/NEJMsa0804116
7. Boulding W, Glickman SW, Manary MP, Schulman KA, Staelin R. Relationship between patient satisfaction with inpatient care and hospital readmission within 30 days. Am J Manag Care. 2011 Jan;17(1):41-8.
8. Weingart SN, Zhu J, Chiappetta L, Stuver SO, Schneider EC, Epstein AM, et al. Hospitalized patients’ participation and its impact on quality of care and patient safety. International Journal for Quality in Health Care. 2011;23(3):269.
9. Campbell EG, Regan S, Gruen RL, Ferris TG, Rao SR, Cleary PD, et al. Professionalism in Medicine: Results of a National Survey of Physicians. Annals of Internal Medicine. 2007;147(11):795-802. doi:10.7326/0003-4819-147-11-200712040-00012
10. Nusbaum NJ. The electronic medical record and Patient-centered care. Online Journal of Public Health Informatics. 2011;3(2):ojphi.v3i2.3721. doi: 10.5210/ojphi.v3i2.3721
11. Krist AH, Woolf SH. A vision for patient-centered health information systems. JAMA. 2011;305(3):300-1. doi:10.1001/jama.2010.2011.
Competing interests:
No competing interests
11 September 2016
Windu Kusumo
Post graduate student of Master of Public Health
Monash University, Australia
Wellington Rd 1/84, Clayton, 3168, Victoria, Australia
Rapid Response:
The importance of patient involvement in the implementation of EHR
Dear Editor,
For the last few years, health providers have invested more attention to achieve meaningful use of electronic health record (EHR) , and less concern has been devoted to review issues on patient safety to improve the quality of care.[1] In their research paper, Barnett et al [2] argue that there is no general correlation between EHR implementation and short-term inpatient mortality, adverse safety events, or readmissions in 17 hospitals in the United States.[2] Regardless of consideration that EHR implementation might unfavorably influence patient treatment during the acute transition time, the authors mentioned that the study results could be justified to ensure its utilization for doctors and hospitals.[2]
However, the study did not involve patients and did not have the intention to announce the findings to the relevant patient community [2], giving the impression that patient interest is rather neglected than the medical outcome in the service delivery setting. One rationale for this is clinicians or researchers often focusing more on the outcome of treatment in defining patient safety, which is different from patients’ perspective that focus more on the process and interpersonal relation.[3]
In my opinion, patients involvement hold the pivotal role in patient safety scheme since they can participate in monitoring and reporting errors and adverse events.[4] Several studies have found the positive association between patient experience and perception of care, and the general indicators of safety and quality in the hospitals. [5,6] Other studies found that greater overall satisfaction level of the patient is associated with lower 30-days risk of hospital readmission [7] and patient’s engagement in their own treatment, such as asking queries or participating in decision-making, is correlated with adverse event reduction.[8]
A national survey in 2007 in the United States found that clinicians often have a tendency not to report an adverse event to authorities.[9] This condition leads to unreported adverse events or errors that could not be captured in the medical record.[9] Many of the previous EHR improvement has focused on collecting objective information, such as medication lists and laboratory results. Less attention has been dedicated to more comprehensive task that could capture patient’s concerns and preferences.[10] EHR could be used as a standardized instrument in carrying out clinical protocols and other procedures to reduce clinical carelessness and other adverse events.[10] For those reasons above, the development of EHR in the clinical setting should incorporate patient involvement.[10]
Despite Barnett et al [2] has identified that the implementation of EHR is not correlating with the serious adverse event in the short term, the technology should be utilized to do more than accessing health data. EHR should also analyze data from various sources and serves as an instrument to simplify action.[11] In term of patient safety, patients should be involved in the design of EHR so the technology could reach its optimal potential.
References:
1. Singh H, Sittig DF. Measuring and improving patient safety through health information technology: The Health IT Safety Framework. BMJ Quality & Safety. 2016;25(4):226-32. doi:10.1136/bmjqs-2015-004486
2. Barnett ML, Mehrotra A, Jena AB. Adverse inpatient outcomes during the transition to a new electronic health record system: observational study. BMJ.2016;354. doi:10.1136/bmj.i.3835.
3. Rathert C, Brandt J, Williams ES. Putting the ‘patient’ in patient safety: a qualitative study of consumer experiences. Health Expectations. 2012;15(3):327-36. doi:10.1111/j.1369-7625.2011.00685.x
4. Rathert C, Huddleston N, Pak Y. Acute care patients discuss the patient role in patient safety. Health care management review. 2011;36(2):134-44.
5. Isaac T, Zaslavsky AM, Cleary PD, Landon BE. The relationship between patients' perception of care and measures of hospital quality and safety. Health Services Research. 2010 2010/08//:1024+. doi: 10.1111/j.1475-6773.2010.01122.x
6. Jha AK, Orav EJ, Zheng J, Epstein AM. Patients' Perception of Hospital Care in the United States. New England Journal of Medicine. 2008;359(18):1921-31. doi: 10.1056/NEJMsa0804116
7. Boulding W, Glickman SW, Manary MP, Schulman KA, Staelin R. Relationship between patient satisfaction with inpatient care and hospital readmission within 30 days. Am J Manag Care. 2011 Jan;17(1):41-8.
8. Weingart SN, Zhu J, Chiappetta L, Stuver SO, Schneider EC, Epstein AM, et al. Hospitalized patients’ participation and its impact on quality of care and patient safety. International Journal for Quality in Health Care. 2011;23(3):269.
9. Campbell EG, Regan S, Gruen RL, Ferris TG, Rao SR, Cleary PD, et al. Professionalism in Medicine: Results of a National Survey of Physicians. Annals of Internal Medicine. 2007;147(11):795-802. doi:10.7326/0003-4819-147-11-200712040-00012
10. Nusbaum NJ. The electronic medical record and Patient-centered care. Online Journal of Public Health Informatics. 2011;3(2):ojphi.v3i2.3721. doi: 10.5210/ojphi.v3i2.3721
11. Krist AH, Woolf SH. A vision for patient-centered health information systems. JAMA. 2011;305(3):300-1. doi:10.1001/jama.2010.2011.
Competing interests: No competing interests