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How Improving Physician EHR Use Can Benefit the Diagnoses

By Sara Heath

Although physician EHR use has many benefits, including increased care coordination and patient engagement, issues with interoperability and health information exchange sometimes hinder the diagnosis process.

Such was the case with the first Ebola patient in Dallas, Texas last year. According to a post by Dean Sittig, PhD, and Hardeep Singh, MD, MPH, there are various different EHR practices that could have been done that may have potentially changed the outcome of the patient’s Ebola diagnosis.

Sittig and Singh based their theories on an Institute of Medicine (IOM) report that made suggestions for best practice uses for EHRs that would make diagnosis easier and more precise. According to the authors, had some of these practices been in place during the time of Ebola Patient Zero’s hospital visits, his diagnosis may have been more effective.

First, Sittig and Singh discussed the care coordination benefits of EHRs and how they may not have been fully utilized at the time of Ebola Patient Zero’s first emergency room visit. Although Ebola Patient Zero’s medical and travel history were taken by the ER nurse, that information was not passed along to the ER doctor, something which may have been prevented had different EHR practices been in place.

We recognize that there are many other ways to improve teamwork but in this day and age a major component of making teams function well is having EHRs that support teamwork and communication. Unfortunately, EHRs are not inherently designed this way and substantive ‘real-world’ usability testing is needed in order for them to do so,” wrote Sittig and Singh.

The authors suggest that EHR interfaces could improve both nurse and physician workflows in such a way that care coordination and teamwork would be better facilitated. For example, note-taking screens should not necessarily distinguish between physician notes and nurse notes, Sittig and Singh suggest. Instead, all members of the care team should be privy to all of the patient’s medical history.

“The ability to review every patient’s complete medical history in a longitudinal manner is a key factor in making an accurate and timely diagnosis. EHR screen designs could be greatly improved if they were shared among all EHR users, regardless of vendor,” the authors wrote.

Furthermore, Sittig and Singh discuss certain misuses of EHR technology. For example, the authors suggest that perhaps EHR quality measures and incentive programs should not always require nurses be tasked with gathering information regarding patient flu vaccination history. The authors maintain that although it is impossible to know whether this change in workflow would have improved Ebola Patient Zero’s diagnosis, it is a commonly acknowledged fact that certain required EHR incentive measures have an effect on how clinicians communicate with patients.

Sittig and Singh state that Ebola Patient Zero is a case study for all of the work that can be done to improve EHR use in diagnostic settings. These improvements can be made through industry collaboration and the sharing of best practices. Furthermore, the pair states that EHRs need interoperability to allow for collaboration and to help paint a complete picture of the patient’s care. Through the participation of policymakers and industry stakeholders, Sittig and Singh state that EHR healthcare can become safer and more effective.

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