Secondary use of electronic health record data of elderly care physicians: how to enhance standardized and structured recording? (Preprint)

Abstract

BACKGROUND Elderly care physicians (ECPs) in nursing homes record information regarding patients’ health, disease and provided care in electronic health records (EHRs). However, much of this health data currently lacks structure and standardization, limiting its potential for the health information exchange of data across care providers, and reuse for quality improvement, policy development and scientific research. To enhance this potential requires insight into the attitudes and behaviors of ECPs towards standardized and structured recording in EHRs. OBJECTIVE The aim of this study is to explore why and how ECPs record their findings in EHRs, as well as the factors that influence them to record in a standardized and structured manner. METHODS Semi-structured interviews were conducted with 13 ECPs working in Dutch nursing homes. We recruited participants through purposive sampling, aiming for diversity in age, gender, healthcare organization, and use of EHR systems. Interviews continued until we reached data saturation. Analysis was performed using inductive thematic analysis. RESULTS ECPs primarily use EHRs to record day-to-day patient care and to ensure continuity of care, and also to meet their obligation to record specific information for accountability reasons. The EHR provides a record that can be used to justify their actions in case of a complaint. In addition, some respondents also mentioned recording information for secondary purposes, such as research and quality improvement. Several factors were found to influence standardized and structured recording. At a personal level, it is crucial to experience the added value of standardized and structured recording. At the organizational level, having clear internal guidelines and attention to their use within the organization can have significant impact. At the level of the EHR system, user-friendliness, interoperability and guidance were most frequently mentioned as being important. At a national level, the alignment of internal guidelines with overarching standards plays a pivotal role in encouraging standardized and structured recording. CONCLUSIONS The results of our study are similar to the findings of previous research in hospital care and general practice. Therefore, long-term care can learn from solutions regarding standardized and structured recording in other healthcare sectors. Primary use in daily patient care and continuity of care are the main motives for ECPs to record in EHRs. Standardized and structured recording can be improved by aligning the recording method in EHRs with the primary care process. In addition, there are incentives for motivating ECPs to record in a standardized and structured way, mainly at the personal, organizational, EHR system, and national levels.