Impact of electronic medical records and COVID‐19 on adult Goals‐of‐Care document completion and revision in hospitalised general medicine patients

Abstract

Background Conversion from paper‐based to electronic medical records (EMR) may affect the quality and timeliness of the completion of Goals‐Of‐Care (GOC) documents during hospital admissions, and the COVID‐19 pandemic may have further impacted this. Aims Determine the impact of EMR and COVID‐19 on the proper completion of GOC forms, and the factors associated with inpatient changes in GOC. Methods We conducted a cross‐sectional study of adult general medicine admissions (Aug 2018‐Sep 2020) at Dandenong Hospital (Victoria, Australia). We used interrupted time series to model the changes in the rates of proper GOC completion (adequate documented discussion, completed ≤2 days) after the introduction of EMR and arrival of COVID‐19. Results We included a total of 5147 patients. The pre‐EMR GOC proper completion rate was 27.7% (overall completion, 86.5%). There was a decrease in the proper completion rate by 2.21% per month (95% CI: −2.83%, −1.58%) after EMR implementation despite an increase in overall completion rates (91.2%). The main reason for the negative trend was a decline in adequate documentation despite improvements in timeliness. COVID‐19 arrival saw a reversal of this negative trend, with proper completion rates increasing by 2.25% per month (95% CI: 1.35%, 3.15%) compared to the EMR period, but also resulted in a higher proportion GOC changes within 2 days of admission. Conclusion EMR improved the timeliness and overall completion rates of GOC at the cost of a lower quality of documented discussion. COVID‐19 reversed the negative trend in proper GOC completion but increased the number of early revisions. This article is protected by copyright. All rights reserved.

The Implementation of an Electronic Medical Record in a German Hospital and the Change in Completeness of Documentation: Longitudinal Document Analysis

“…However, the similarity between the coded ICD diagnoses over different years (Table 1) suggests that the proven changes in completeness of documentation are not due to significant changes in the studied patient sample, but a detailed sample description based on socioeconomical data is missing due to data protection regulations. On the other hand, there is a study assuming a positive influence of the pandemic on the completeness of documentation since an incomplete documentation might have led to repetitive contacts with the patient, which could have been avoided if the documentation would have been complete in the first place [39]. However, this cannot be verified in this paper due to the lack of further measuring phases.…”