A systematic review of the use of the electronic health record for patient identification, communication, and clinical support in palliative care

Abstract

Objectives Globally, healthcare systems are using the electronic health record (EHR) and elements of clinical decision support (CDS) to facilitate palliative care (PC). Examination of published results is needed to determine if the EHR is successfully supporting the multidisciplinary nature and complexity of PC by identifying applications, methodology, outcomes, and barriers of active incorporation of the EHR in PC clinical workflow. Methods A systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The data sources PubMed, CINAL, EBSCOhost, and Academic Search Premier were used to identify literature published 1999–2017 of human subject peer-reviewed articles in English containing original research about the EHR and PC. Results The search returned 433 articles, 30 of which met inclusion criteria. Most studies were feasibility studies or retrospective cohort analyses; one study incorporated prospective longitudinal mixed methods. Twenty-three of 30 (77%) were published after 2014. The review identified five major areas in which the EHR is used to support PC. Studies focused on CDS to: identify individuals who could benefit from PC; electronic advanced care planning (ACP) documentation; patient-reported outcome measures (PROMs) such as rapid, real-time pain feedback; to augment EHR PC data capture capabilities; and to enhance interdisciplinary communication and care. Discussion Beginning in 2015, there was a proliferation of articles about PC and EHRs, suggesting increasing incorporation of and research about the EHR with PC. This review indicates the EHR is underutilized for PC CDS, facilitating PROMs, and capturing ACPs.

Design and implementation of a clinical decision support tool for primary palliative Care for Emergency Medicine (PRIM-ER)

“…Overall, there is a dearth of literature on CDS development and implementation in the context of palliative care, as well as integration in an ED setting [34]. To date, what is known is that CDS tools can play an integral role in assisting healthcare providers in providing patients optimal care by providing patient-specific recommendations at the point of need [11,35].…”

Digital Health Interventions in Palliative Care: A Systematic Meta-Review and Evidence Synthesis

“…Three reviews focused on cancer, [21][22][23] others did not limit their inclusion criteria a specific disease. The reviews were carried out by research teams based in the following countries: USA (9), 17,[24][25][26][27][28][29][30][31] UK (6), 16,23,[32][33][34][35] Australia (2), 14,36 Canada (1) 22 Chile (1), 15 Denmark (1) 37 and Brazil (1) 38 .…”

“…Thirteen reviews referenced the role of DHIs in monitoring, assessing, and managing physical and psychological symptoms. [14][15][16][17][22][23][24][25]27,30,31,34,37 EHRs were used to record symptoms 27,34 while telephone and videoconferencing were frequently used to monitor, assess and treat symptoms. 15,22,23,25,30,37,39 Some reviews described positive impacts of DHIs on symptom management, while most reviews identified inconsistent evidence or noted that evaluation of impact in many studies was lacking.…”

“…Nine reviews considered the information-sharing value of DHIs, with most describing the value of the information rather than evaluating specific outcomes. 15,16,23,[26][27][28]35,36 In an early low quality review of internet use, Willis et al described the positive impacts of the internet as an additional source of information for patients, families and clinicians. 26 They found that patients and carers used online support groups and chatrooms to exchange information and support about an illness and alternative treatments.…”

“…Four reviews highlighted the information-sharing function of EHRs in palliative care. 27,28,35,36 All were moderate quality. These reviews concluded that EHRs available across settings and platforms allow patient preferences regarding advance care planning (ACP) to be shared; improving continuity of care and ensuring that patients are treated in line with their wishes.…”