Using electronic health record systems in diabetes care

Abstract

While there has been considerable attention devoted to the deployment of electronic health record (EHR) systems, there has been far less attention given to their appropriation for use in clinical encounters — particularly in the context of complex, chronic illness. The Department of Veterans’ Affairs (VA) has been at the forefront of EHR adoption and, as such, provides a unique opportunity to examine a mature EHR system in widespread use. Moreover, with a high prevalence of diabetes in its patient population, the VA provides a useful platform for examining EHR use in the context of chronic disease care. We conducted a sequential, exploratory qualitative study at two VA Medical Centers in the Midwest. First, we conducted observations of 64 clinical consultations with diabetes patients. These observations involved 31 different health care providers. Second, using insights from these observations, we conducted in-depth, semi-structured interviews with 39 health care providers focusing on their use of information in diabetes patient care. Field notes and interview transcripts were analyzed using a grounded theory approach. Our analysis generated several categories of EHR use in clinical encounters: priming, structuring, assessing, informing, and continuing. We also outline some mismatches between EHR system design and VA diabetes care practices. We conclude by discussing implications of these emergent system uses for improving the software design of EHRs to better support chronic disease care, as well as for our understanding of the integration of technologies in health care.

Information use in chronic illness care: The role of the electronic health record in bridging patient experience and healthcare contexts

“…The innovations observed here in providers' use of the EHR as a platform for patient education, communication, and trust suggest that it has the potential to be perceived and adopted as a useful tool in managing chronic illness. Previous research has concluded that aligning the EHR structure more closely with providers' use of it could facilitate its adoption (Veinot, et al, 2010). The findings of this study suggest that EHR effectiveness may also benefit from a closer alignment with patients' everyday life experience of chronic illness.…”

“…However, research focusing on the impact of the EHR on the patient-provider relationship is still nascent. Previous work from this study has looked at providers' appropriations of the EHR in their clinical care work (Veinot, Souden, Zheng, Keith, & Lowery, 2010). This paper extends that research to examine the power of EHR use in shaping patient experiences of chronic illness care through its impact on provider information use and provider-patient interaction.…”

Comprehensive process model of clinical information interaction in primary care: results of a “best-fit” framework synthesis

“…Clinicians use EHRs to review and record information about patients, including problem lists, current therapies, test results, and patient assessments. 69 The EHR box is also shaded, since this is a usual source of information.…”

Structuring Clinical Workflows for Diabetes Care

“…Extending the classification proposed by Veinot et al [27] for classifying patient-centered EHR use in clinical consultations, context of use can be categorized by: "Priming" (n = 8), "Structuring" (n = 5), "Assessing & Diagnosis" (n = 14), "Informing and Awareness" (n = 138), and "Continuing and Monitoring" (n = 10). Examples of selected statements concerning a certain Context are shown in ▶…”

“…Example Source Statement "The records of Type 2 diabetics were searched for … glycosylated haemoglobin (HbA 1c )." [28] "… interpret the results of blood glucose self-monitoring …" [43] "… some providers combined patient data sets in order to help patients understand the health consequences" [27] "… doctors monitor patients' levels of adherence to care processes (e.g. annual assessment, review visits, education sessions, laboratory tests) and self management as well as their status of attainment of treatment targets."…”