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

Tom Bowden,Enrico Coiera

doi:10.1186/s12911-017-0523-4

Tom Bowden, Enrico Coiera

Open Access

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

Copy DOI

Abstract

BackgroundThe 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.ResultsTwenty-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.ConclusionsDespite 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.

Highlights

The purpose of this study was to assess the impact of accessing primary care records on unscheduled care
Utilization of records in unscheduled care The rate at which Shared electronic health record (SEHR) were accessed by clinicians was less well reported (Table 2)
Taken as a whole this suggests that, at least for this globallysignificant class of system, the drivers for system design, development and operation are not yet evidence-based. This is underscored by the absence of peer-reviewed studies for many long-running national SEHRs such as Australia’s My Health Record system, Singapore’s National Electronic Health Record (NEHR) system, Hong Kong’s Electronic Health Record Sharing System and Regional Health Information Exchange Organisations (RHIOs) in the US

Summary

Introduction

The purpose of this study was to assess the impact of accessing primary care records on unscheduled care. Studies published to December 2014 reporting on primary care record access during unscheduled care were retrieved. One of the key justifications for developing Shared Electronic Health Records (SEHRs) is their potential to improve the quality and outcome of care for unanticipated or unscheduled events such as emergencies. Some are special-purpose ‘summary care records’ stored in centralized repositories [2]. Others, such as some Health Information Exchanges (HIEs), take a decentralized approach by creating a virtual health record that is assembled from working clinical record systems. Other nations take a less-direct “middle-out” approach, emphasizing the development of interoperability standards and encouraging the IT industry to work directly with the healthcare system [3, 4]

Objectives

Methods

Results

Discussion

Conclusion