Let’s assume you are buying a new electronic health record for your hospital. You have got a fair budget, good oversight of the market and a motivated team to help you select and implement the system. Let’s just assume that could be your starting position….
How would you choose? Functionality might be similar in many systems, you can enter and extract data, audit entries. Things should feel right: the user surface should be intuitive, the architecture should be easy to understand.
You pick a great system and start working with it. How would you know that it is better than the old one? How would you evaluate the results of implementation a year down the line?
Simple things first: How many users have logged on? How many complaints you had? How much time people spend with the record and how much with patients?
But safety is a really key topic (http://www.who.int/features/factfiles/patient_safety/patient_safety_facts/en/). How would you know if your new system is safer? What adverse events would you expect to prevent with the implementation? And which might have increased by going all electronic?
Good access to information would seem a no brainer for safer systems. Giving doctors and nurses all available information at the click of a mouse should improve their decision making. But maters are probably not that simple. Only few studies have found changes in patient safety after the implementation of an electronic patient record.
There could be several reasons for this:
- Electronic patient records might depend on organizational culture to be properly implemented. In a great organization a bit of electronics does not make things that much better, in an organization with weak culture nobody is going to worry about the safety features. Some of the conditions that are needed for patient safety are summarized in this WHO document: http://nes.scot.nhs.uk/media/2729328/nes_support_for_who_ps_topics.pdf
- EPRs are just not that good: they don’t give you the right information or overload you with too much junk: http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1657753.