Hospitals with computerized systems that allow electronic clinical documentation, by component, 2011-2013 1. Meta-analysis showed an association between EHR use and a reduced documentation time with a difference in mean of −22.4% [95% confidence interval (CI) = −38.8 to −6.0%; P < 0.007]. Column heading 1 signifies the best response for each question, 2 the second best, and so on. However, our study has also its limitations. G . Currently, there is a paucity of data in this area, and existing research offers conflicting results. Questions 9 through 14 are Likert‐scalebased items included to evaluate the quality of communication between patient and provider. All 16 questions assessing physician‐patient communication received better responses in the 3 months following EHR implementation, compared to the 3 months prior to implementation. Laird An example of an effective strategy may be identified through the WHO guidelines for EHR in developing countries 18 and reassumed in six key actions: – review the current health record system. All surveyors were evaluated biyearly by their peers and the program director for quality assurance and to ensure uniform procedures. Possible source of such heterogeneity includes difference in the software used, their quality and usability, and different settings of implementation. The Global Society on Migration, Ethnicity, Race and Health: why race can’t be ignored even if it causes discomfort, Infant mortality among native-born children of immigrants in France, 2008–17: results from a socio-demographic panel survey, ‘Race’ causes discomfort? Therefore, strategies for EHR implementation should be recommended and promoted. Increasingly, as patients' medical records become electronic, they stand to become more important than ever before. Limitations to this study should be considered. The presence of publication bias was assessed using a visual funnel plot inspection and Egger’s test. Copyright © by Society of Hospital Medicine or related companies. 5 Accordingly, the impact of EHRs on quality healthcare delivery has … Of these, 9 questions illustrated statistically significant improvement, whereas the improvement in the remaining 7 questions was not statistically significant.DISCUSSIONThese results suggest that EHRs may improve physician‐patient communication. [27]CI‐CARE QuestionnaireARC SurveyThe CI‐CARE Questionnaire is a standardized audit tool consisting of a total of 20 questions used by the facilitators who work with ARC. C David The medical record, either paper-based or electronic, is a communication tool that supports clinical decision making, coordination of services, evaluation of the quality and efficacy of care, research, legal protection, education, and accreditation and regulat… In our opinion, it is likely that there are cases where the success of EHR was not reached because of a non-effective implementation strategy. ARC and UCLA Health's EHR can serve as a model for residency programs nationwide. : can we maximize their benefits and minimize their risks? All data extractions were conducted independently by two reviewers, and disagreements were resolved through discussion. [21], One of the limitations of EHRs has been the reported negative impact on patient‐centered care by decreasing communication during the hospital visit. Alarming reports of deaths, serious injuries and near misses — thousands of them — tied to software … Consequently, EHR can determine also a reduction of costs associated with medical errors, ADEs and time inefficiency. Furthermore, they were perceived to provide significantly better communication quality following implementation, through care monitoring, respectful and sensitive communication, and enhanced patient and family education. All statistical tests were performed with Comprehensive Meta-Analysis software version 2.2.064 (Biostat, Englewood, NJ). Furthermore, the authors thank the student volunteers and interns of the ARC Medical program for their commitment and effort to optimize the patient experience. The ARC Survey targets specific areas of the residents' care as outlined by the CI‐CARE Program of UCLA Health.As part of UCLA Health's mission to ensure the highest level of patient‐centered care, the CI‐CARE standards were introduced in 2006, followed by implementation of the EHR system. Possible barriers that may contribute to the scarcity of literature include the relatively recent large‐scale implementation of EHRs and a lack of programs in place to collect extensive data on the physician‐patient relationship.In a field with increasing demands on patient‐centered care, we need to find ways to preserve and foster the patient‐physician relationship. Today however, new and ever-improving technologies allow for the health and care history of patients to now be tracked using electronic health records. Residents were also perceived as being more professional following implementation, as indicated by positive assessments of several interpersonal communication questions. EV There were a total of 3414 interviews conducted and completed from December 1, 2012 to May 30, 2013. All rights reserved. Furthermore, they were perceived to provide significantly better communication quality following implementation, through care monitoring, respectful and sensitive communication, and enhanced patient and family education. Following EHR implementation, residents were perceived to provide more frequent diagnostics information including the nature, impact, and treatment of conditions. Further research is therefore needed to determine the differences among the various system, the different items that shape an EHR software, and the different benefits of any of them. Codish These results suggest that implementing an EHR may be an effective way to meet these increasing demands on patient‐centered care. The notion that implementing an EHR might enhance provider‐patient communication is a powerful concept.This study not only suggests the improvement of resident‐patient communication due to the implementation of an EHR, but it also reveals the value of the ARC Medical Program for studying the patient experience. oversaw the program. Rosen This author conducted a literature review using the PubMed database with the following search terms: patient-centered care, nursing, technology, electronic health record, and impact. No question on the ARC survey received lower scores following implementation of the EHR. 3. However, we did not anticipate a significant change in the patient population that would alter the survey responses during this 6‐month period. Han JC It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. An electronic health record (EHR) is a systematic electronic collection of health information about patients such as medical history, medication orders, vital signs, laboratory results, radiology reports, and physician and nurse notes. . Swensen Stack Due to the nature of our data collection, we were unable to control for many confounding variables, thus causal conclusions are difficult to draw from these results.There are a few important trends to note. C Health information technology systems are, in fact, healthcare interventions, and systems for evaluating their efficacy and safety should be as robust as those evaluating other healthcare technologies. A The surveyors are trained not to probe for responses, and to ensure that the patients answer in accordance with the possible responses. Publication bias was not evident. An EHR may also include a decision support system (DSS) that provides up-to-date medical knowledge, reminders or other actions that aid health professionals in decision making. – involve the anticipated users of the system from the onset of discussions. Journal of Hospital Medicine 2014;9:627–633. The ARC Medical Program is primarily used as an education tool for resident physicians, so all of our data are specific to resident physicians. Altogether, 1567 surveys were collected 3 months prior to EHR implementation (DecemberFebruary), and 1847 surveys were collected 3 months following implementation (MarchMay). This meta-analysis provides evidence that the use of EHR can improve the quality of healthcare, increasing time efficiency and guideline adherence and reducing medication errors and ADEs. These results suggest that EHRs may improve physician‐patient communication. – evaluate the benefits of the implemented system. 15 Moreover, several studies have reported that the use of appropriate information technology in the delivery of healthcare may also improve hospital efficiency, with benefits exceeding the costs of adoption 16 and patient satisfaction rating. How Electronic Health Records Affect Healthcare The systematic process of keeping patient medical records has long been a staple of the healthcare industry. The controlled, prolonged, and efficient nature of the ARC Medical Program's data collection was ideal for comparing a change in resident‐patient communication before and after EHR implementation at UCLA Health. Strategies for EHR implementation should be recommended and promoted. Patient‐centered care is a critical objective for many high‐quality healthcare systems. M The researchers reviewed and evaluated all data gathered using standard protocols. High heterogeneity among the studies regarding documentation time (Q test P < 0.001 and I 2 = 92.4%), guideline adherence (Q test P < 0.001 and I 2 = 91.9%), medication errors (Q test P < 0.001 and I 2 = 97.7%) and ADEs (Q test P < 0.001 and I 2 = 80.8%) was evident. CI‐CARE represents the standards for staff and providers in any encounter with patients or their families. Due to the nature of our data collection, we were unable to control for many confounding variables, thus causal conclusions are difficult to draw from these results. The ARC Medical Program has an established infrastructure to conduct evaluations on a system‐wide scale, including 9 departments within UCLA Health. Sensitivity analysis has shown the stability of the overall effect sizes with the withdrawal of any of the study from the analysis without a significant improvement of the heterogeneity. Please check for further notifications by email. M [22] Furthermore, the average hospital length of stay has been increased due to the use of EHRs. Searching the online databases resulted in 23 398 articles from PubMed, Web of Knowledge, Scopus and Cochrane Library. Lim EHR resulted also associated with a higher guideline adherence with a risk ratio (RR) of 1.33 (95% CI = 1.01 to 1.76; P = 0.049) and a lower number of medication errors with an overall RR of 0.46 (95% CI = 0.38 to 0.55; P < 0.001), and adverse drug effects (ADEs) with an overall RR of 0.66 (95% CI = 0.44 to 0.99; P = 0.045). Surveys were analyzed to assess physician‐patient communication. We categorized questions 5 and 15 as relating to diagnostics. DG Results: Of the 23 398 citations identified, 47 articles were included in the analysis. A.A.N. et al. Furthermore, the authors thank the student volunteers and interns of the ARC Medical program for their commitment and effort to optimize the patient experience. Residents were also perceived as being more professional following implementation, as indicated by positive assessments of several interpersonal communication questions. et al. According to Versel (2013), “Electronic health records … ARC and UCLA Health's EHR can serve as a model for residency programs nationwide. EHR including DSS, that actively provides up-to-date medical knowledge, reminders or other actions that aid health professionals in decision making, showed in fact generally a better outcome. [20] Additionally, poor EHR system design and improper use can cause errors that jeopardize the integrity of the information inputted, leading to inaccuracies that endanger patient safety or decrease the quality of care. [19] Some studies have also noted an increase in the ability for medical history retrieval and analysis, which will ultimately increase the quality of care provided to the patient. The goals of the ARC Medical Program are to monitor housestaff performance and patient satisfaction while improving trainee education through timely and patient‐centered feedback. Currently, there is a paucity of data in this area, and existing research offers conflicting results. These significant differences were likely not due to the residents improving through time and experience. Furthermore, these studies have not yielded consistent results,[19, 20, 21, 22, 23, 25] raising uncertainty about the effects of EHRs on the patient experience. However, we did not anticipate a significant change in the patient population that would alter the survey responses during this 6‐month period. Possible barriers that may contribute to the scarcity of literature include the relatively recent large‐scale implementation of EHRs and a lack of programs in place to collect extensive data on the physician‐patient relationship. . However, the absence of association with ADEs reduction for the subgroup of studies not using DSS is probably due to the limitation of having only three studies in this subgroup. The survey breakdown is summarized in Table 1.Table 1.Survey Breakdown Three Months Before and After Electronic Health Record ImplementationDepartmentPre (N)Post (N)Total (N)NOTE: Abbreviations: OB/GYN, obstetrics/gynecology.Family medicine65128193General surgery226246472Head and neck surgery4365108Internal medicine439369808Neurology8198179Neurosurgery9954153OB/GYN173199372Orthopedic surgery117128245Pediatrics324563887Totals1,5671,8503,4172 analysis revealed that the residents received significantly better feedback in the 3 months following EHR implementation, compared to the 3 months prior to implementation on questions 3, addressing the patient by their preferred name; 4, introducing themselves and their role; 5, communicating what they will do, how long it will take, and how it will impact the patient; 7, responding to the patient's requests and questions with immediacy; 8, listening to the patient's questions and concerns; 9, doing their utmost to ensure the patient receives the best care; 10, communicating well with the patient; 11, being respectful and considerate; and 12, being sensitive to the patient's physical and emotional needs (P<0.05) (Table 2).Table 2.Analysis of Responses Three Months Before and After EHR Implementation QuestionPre‐EHR % Responses (n=1,567)Post‐EHR % Responses (n=1,850)2 Significance1234512345NOTE: Abbreviations: EHR, electronic health record. . 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