Advice for Decision Makers Based on an Electronic Health Record Evaluation at a Program for All-inclusive Care for Elders Site

Abstract

SummaryObjective: Provide evidence-based advise to "Program of All-inclusive Care for the Elderly" (PACE) decision makers considering implementing an electronic health record (EHR) system, drawing on the results of a mixed methods study to examine: (1) the diffusion of an EHR among clinicians documenting direct patient care in a PACE day care site, (2) the impact of the use of the EHR on the satisfaction levels of clinicians, and (3) the impact of the use of the EHR on patient functional outcomes. Methods: Embedded mixed methods design with a post-test design quantitative experiment and concurrent qualitative component. Quantitative methods included: (1) the EHR audit log used to determine the frequency and timing during the week of clinicians' usage of the system; (2) a 22-item clinician satisfaction survey; and (3) a 16-item patient functional outcome questionnaire related to locomotion, mobility, personal hygiene, dressing, feeding as well the use of adaptive devices. Qualitative methods included observations and open-ended, semi-structured follow-up interviews. Qualitative data was merged with the quantitative data by comparing the findings along themes. The setting was a PACE utilizing an EHR in Philadelphia: PACE manages the care of nursing-home eligible members to enable them to avoid nursing home admission and reside in their homes. Participants were 39 clinicians on the multi-disciplinary teams caring for the elders and 338 PACE members. Results: Clinicians did not use the system as intended, which may help to explain why the benefits related to clinical processes and patient outcomes as expected for an EHR were not reflected in the results. Clinicians were satisfied with the EHR, although there was a non-significant decline between 11 and 17 months post implementation of the EHR. There was no significant difference in patient functional outcome the two time periods. However, the sample size of 48 was too small to allow any conclusive statements to be made. Interpretation of findings underscores the importance of the interaction of workflow and EHR functionality and usability to impact clinician satisfaction, efficiency, and clinician use of the EHR. Conclusion: This research provides insights into EHR use in the care of the older people in community-based health care settings. This study assessed the adoption of an EHR outside the acute hospital setting and in the community setting to provide evidence-based recommendations to PACE decision makers considering implementing an EHR. There is a lack of evidence that shows the effect that patient outcomes improve when clinicians use an EHR in primary care, [7,8] specialty care, [9] or long-term care [10]. The yet to be documented promise of EHRs, combined with concerns with unintended consequences, underscores the continued need for evaluation studies.This situation is notable in the geriatric setting, where informatics evaluation studies are rare. The lack of informatics studies may be due to two possible trends: 1. university-based informaticians tend to ...

Impact of Electronic Health Records on Long-Term Care Facilities: Systematic Review

“…Notably, only three out of 28 papers (11%) reported greater physician satisfaction using EHRs, as it improved working environment and reduced errors [ 34 , 37 , 38 ]. Also, three attributes were mentioned only twice out of 28 papers: patient satisfaction [ 36 , 48 ], medication safety [ 42 , 44 ], and cost [ 23 , 41 ], each of which represent 5% of total occurrences of attributes in the literature.…”

Challenges and Facilitators to Adoption of a Point-of-Care Electronic Health Record in Home Care

“…We have confidence in the methods used in this study as the research team has previously used these methods in another community health care setting (Sockolow, Weiner, Bowles, Abbott, & Lehmann, 2011). The validated satisfaction survey, EHRNS, had a slightly lower than expected return rate.…”

“…Clinicians who were observed were also interviewed. The open-ended interview questions embodied the major themes identified in previous clinician satisfaction interviews in a different setting (Sockolow, Weiner, Bowles, Abbott, & Lehmann, 2011) and are shown in Table 1. Responses were recorded and transcribed.…”

“…Qualitative data was analyzed using thematic content analysis. Researchers (PS, KB) conducted mixed methods analysis by sorting results from each data source by theme, referring to the HIT Reference-based Evaluation Framework (HITREF; Sockolow, Weiner, Bowles, Abbott, & Lehmann, 2011) and summarizing themes in a matrix. The HITREF, a comprehensive HIT evaluation framework firmly grounded in research evidence, was used to identify a range of HIT characteristics and dimensions to be measured.…”

The Use of Health Information Exchange to Augment Patient Handoff in Long-Term Care: A Systematic Review

“…37 Significant research has been conducted on hospital readmissions from the LTC setting, but not enough research has been conducted on successful mechanisms to prevent readmissions. 38 Future research should focus on the need to increase financial incentives for LTC facilities to implement HIE mechanisms, as well as the actuarial effect of readmissions on LTC facilities as financial penalties become more stringent. This systematic review serves as a good foundation for extensive research to establish best practices.…”