Letters Transition to electronic health records

The importance of patient involvement in implementing electronic health record systems

BMJ 2016; 354 doi: https://doi.org/10.1136/bmj.i5035 (Published 20 September 2016) Cite this as: BMJ 2016;354:i5035
  1. Windu Kusumo, postgraduate student of master of public health
  1. Monash University, Wellington Road, Clayton, VIC 3800, Australia
  1. kusumowindu{at}gmail.com

Health providers have paid much attention to the meaningful use of electronic health records (EHRs), but less concern has been devoted to reviewing patient safety.1 In their study,2 Barnett and colleagues found no general correlation between EHR implementation and short term inpatient mortality, adverse events, or readmissions in 17 hospitals in the US.2

However, the researchers did not involve patients and did not intend to announce the findings to the patient community,2 suggesting that patient interest is rather neglected in relation to medical outcomes in care delivery. One rationale for this is that clinicians or researchers often focus more on treatment outcomes in defining patient safety, whereas patients focus on processes and interpersonal relations.3

In my opinion, patients hold a pivotal role in patient safety schemes, since they can participate in monitoring and reporting adverse events.4 Several studies have found a positive association between patient experience and perception of care, safety, and quality.5 6 Other studies found that greater overall satisfaction in patients is associated with a lower 30 day risk of hospital readmission,7 and patients’ engagement in their own treatment is correlated with fewer adverse events.8

A national survey in the US found that clinicians tend not to report errors, which leads to under-reported adverse events in medical records.9 Many previous EHR improvements have focused on collecting objective information but have paid less attention to capturing patients’ concerns and preferences.10 EHRs could be used as a standardised instrument for performing clinical protocols to reduce clinical carelessness,10 as well as simplifying processes.11 In terms of patient safety, patients should be involved in EHR design, to maximise the technology’s potential.



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