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Title : An Interesting If Slightly Out Of Date Study That Suggests There Is A Lot Of Work To Do To Show Shared Health Records Are Useful In Urgent Care.
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An Interesting If Slightly Out Of Date Study That Suggests There Is A Lot Of Work To Do To Show Shared Health Records Are Useful In Urgent Care.

The following was published on September 22, 2017.

The abstract reads:

The role and benefits of accessing primary care patient records during unscheduled care: a systematic review

• Tom Bowden and
• Enrico Coiera

BMC Medical Informatics and Decision MakingBMC series – open, inclusive and trusted201717:138

https://doi.org/10.1186/s12911-017-0523-4

Received: 26 December 2016

Accepted: 8 August 2017

Published: 22 September 2017

Abstract

Background

The purpose of this study was to assess the impact of accessing primary care records on unscheduled care. Unscheduled care is typically delivered in hospital Emergency Departments. Studies published to December 2014 reporting on primary care record access during unscheduled care were retrieved.

Results

Twenty-two articles met inclusion criteria from a pool of 192. Many shared electronic health records (SEHRs) were large in scale, servicing many millions of patients. Reported utilization rates by clinicians was variable, with rates >20% amongst health management organizations but much lower in nation-scale systems. No study reported on clinical outcomes or patient safety, and no economic studies of SEHR access during unscheduled care were available. Design factors that may affect utilization included consent and access models, SEHR content, and system usability and reliability.

Conclusions

Despite their size and expense, SEHRs designed to support unscheduled care have been poorly evaluated, and it is not possible to draw conclusions about any likely benefits associated with their use. Heterogeneity across the systems and the populations they serve make generalization about system design or performance difficult. None of the reviewed studies used a theoretical model to guide evaluation. Value of Information models may be a useful theoretical approach to design evaluation metrics, facilitating comparison across systems in future studies. Well-designed SEHRs should in principle be capable of improving the efficiency, quality and safety of unscheduled care, but at present the evidence for such benefits is weak, largely because it has not been sought.

The conclusion of the study in detail reads:

Conclusions

Shared electronic records, if well designed and appropriately targeted to meet specific and high value informational needs, should in principle improve the quality, safety and effectiveness of clinical care. At present however, the evidence for such benefits is weak, largely because it has not been sought. Given the scale and cost of such systems, this absence of evidence is both surprising and concerning.

It is also the case that there has been little clarity in connecting the informational needs which arise during unscheduled care with system design and scale. The lack of theoretical models to underpin SEHR design and evaluation means that some of the systems surveyed may not have been fit for purpose [33], but rather were generic technology driven endeavours. Seeing the SEHR as part of an information value chain emphasizes that information delivery must be connected to decision making, for example through decision support systems, to deliver the most value.

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The really sad thing about this study is that the closure date for publications probably means that we are still ignorant of any quality studies that have been finalized since mid 2013 (allowing for the publication delay). That is thus really 4 years ago and it is more than possible things have improved, or maybe not - who knows?

Nevertheless there has been time for the studies reported to prove their merit.

I share the concern of the authors that some projects have been running for years, have cost a fortune and have not been yet evaluated. One can only speculate as to why that might be!

I wonder will we get some better evidence from the trials the ADHA is funding which may conclude and be published some time in 2019 as I understand it. Surely we should stop spending until the results are in? Would that speed evidence up?

All in all, in Australia, we are spending billions in a evidence free environment. It must be that the people just was to rush ahead, be paid a salary, spend heaps  and not be at all accountable for your and my money! Or maybe it is just that the ADHA feels trapped in the past and politics and has no will to do better?

What a shambles!

David.

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