June 13, 2019
Electronic health records (EHR), while beneficial to the digital revolution, are causing a lot of frustration and opening patients up to potential risk due to variations, according to a study published in the Journal of General Internal Medicine.
Genna Cohen, PhD student at the University of Michigan’s School of Public Health, and colleagues noted that physician to physician variation in EHR documentation not driven by a patients’ clinical status could be harmful. For example, physicians treating the same patients could be entering clinical data in different places on a chart, spend more time searching for information, or recording repeated information, rendering the EHR inefficient.
Ms Cohen and colleagues observed data from a collection of 170,000 patient encounters with 800 physicians in 237 practices. The study also included interviewing 40 physicians in 10 primary care practices.
From the data, Ms Cohen and colleagues discovered significant variations in documentation for five categories of clinical information record by physicians due to different in options and implementation practices for respective EHR systems.
“Five clinical documentation categories had substantial and statistically significant (p < 0.001) variation at the physician level after accounting for state, organization, and practice levels,” explained the researchers.
- Discussing results (IQR = 50.8%, proportion of variation explained by physician level = 78.1%);
- Assessment and diagnosis (IQR = 60.4%, physician-level variation = 76.0%);
- Problem list (IQR = 73.1%, physician-level variation = 70.1%);
- Review of systems (IQR = 62.3%, physician-level variation = 67.7%); and
- Social history (IQR = 53.3%, physician-level variation = 62.2%).
These variations put a strain on patient-physician interaction, quality of care, and could cost practices more money as physicians waste time searching for information.
Much of the issue with variation could be solved with training and standardizing practices, noted Ms Cohen and colleagues. However, the researchers noted that issues with EHR ‘"manifest as small, frequent annoyances rather than substantial, salient problems,” which results in delays of standardization.
Cohen, G.R., Friedman, C.P., Ryan, A.M. et al. Variation in physicians’ electronic health record documentation and potential patient harm from that variation. Journal of General Internal Medicine. 2019. https://doi.org/10.1007/s11606-019-05025-3. Accessed June 13, 2019