Electronic health records: a new tool to combat chronic kidney disease?

Abstract

Electronic health records (EHRs) were first developed in the 1960s as clinical information systems for document storage and retrieval. Adoption of EHRs has increased in the developed world and is increasing in developing countries. Studies have shown that quality of patient care is improved among health centers with EHRs. In this article, we review the structure and function of EHRs along with an examination of its potential application in CKD care and research. Well-designed patient registries using EHRs data allow for improved aggregation of patient data for quality improvement and to facilitate clinical research. Preliminary data from the United States and other countries have demonstrated that CKD care might improve with use of EHRs-based programs. We recently developed a CKD registry derived from EHRs data at our institution and complimented the registry with other patient details from the United States Renal Data System and the Social Security Death Index. This registry allows us to conduct a EHRs-based clinical trial that examines whether empowering patients with a personal health record or patient navigators improves CKD care, along with identifying participants for other clinical trials and conducting health services research. EHRs use have shown promising results in some settings, but not in others, perhaps attributed to the differences in EHRs adoption rates and varying functionality. Thus, future studies should explore the optimal methods of using EHRs to improve CKD care and research at the individual patient level, health system and population levels.

Disparities in Electronic Health Record Patient Portal Use in Nephrology Clinics

“…Because portal use may itself serve as a marker of patient engagement, additional studies are needed to confirm our findings and to explore other potential health benefits in a nephrology setting. For example, portals can be modified to include CKD educational information (17,75), medication safety checks in the setting of impaired renal function (76), dietary guidance (77), and checklists and reminders regarding kidney transplant evaluation (17). Randomized controlled trials are needed to overcome potential confounding due to patient-level variables (e.g., health literacy, patient activation) that we could not discern.…”

“…Portals are personalized health record applications tethered to a provider's EHR. Most portals allow patients to review problem lists, laboratory results, and medications; schedule appointments; request prescription refills; and securely message their providers, thereby facilitating self-monitoring, self-care, and communication (17,(20)(21)(22)(23)27). However, differences in Internet access (i.e., the digital divide), computer literacy and Internet proficiency, as well as patient attitudes may limit portal adoption (28)(29)(30)(31).…”

“…Patient activation (the "knowledge, skills and confidence" needed to actively engage in care) (12) is a critical feature of CKD management, wherein BP self-monitoring, dietary modification, medication adherence, nephrotoxin avoidance, and patient-provider collaboration are essential (13)(14)(15)(16). Enabling patients with CKD to easily access their medical information is a novel approach to facilitate patient engagement and activation (17). In other chronic disease settings, empowering patients in this fashion improves disease knowledge, enhances patient-provider communication, and increases adherence to treatment (18)(19)(20)(21)(22)(23).…”

CKD as a Model for Improving Chronic Disease Care through Electronic Health Records

“…Unfortunately, the majority of these early efforts have been isolated to single institutions, required significant resources to develop, and have not been adopted by other organizations. Navaneethan et al (24) outline potential applications of EHRs for CKD identification and management within an individual health care system. This paper aims to build on that discussion by presenting general goals and a framework for more widespread implementation and use of these evolving tools and resources.…”

Electronic Health Records: Applications, Techniques and Challenges

“…In addition, the value of the personal health records (PHRs) depends on patient's interest of their health condition. Thus, dependence on health records should involve patient awareness and education about provider education to improve EHRs efficient use [52].…”