The Role of Electronic Medical Records in Reducing Unwarranted Clinical Variation in Acute Health Care: Systematic Review

Abstract

Background The use of electronic medical records (EMRs)/electronic health records (EHRs) provides potential to reduce unwarranted clinical variation and thereby improve patient health care outcomes. Minimization of unwarranted clinical variation may raise and refine the standard of patient care provided and satisfy the quadruple aim of health care. Objective A systematic review of the impact of EMRs and specific subcomponents (PowerPlans/SmartSets) on variation in clinical care processes in hospital settings was undertaken to summarize the existing literature on the effects of EMRs on clinical variation and patient outcomes. Methods Articles from January 2000 to November 2020 were identified through a comprehensive search that examined EMRs/EHRs and clinical variation or PowerPlans/SmartSets. Thirty-six articles met the inclusion criteria. Articles were examined for evidence for EMR-induced changes in variation and effects on health care outcomes and mapped to the quadruple aim of health care. Results Most of the studies reported positive effects of EMR-related interventions (30/36, 83%). All of the 36 included studies discussed clinical variation, but only half measured it (18/36, 50%). Those studies that measured variation generally examined how changes to variation affected individual patient care (11/36, 31%) or costs (9/36, 25%), while other outcomes (population health and clinician experience) were seldom studied. High-quality study designs were rare. Conclusions The literature provides some evidence that EMRs can help reduce unwarranted clinical variation and thereby improve health care outcomes. However, the evidence is surprisingly thin because of insufficient attention to the measurement of clinical variation, and to the chain of evidence from EMRs to variation in clinical practices to health care outcomes.

Research and Application of Artificial Intelligence Based on Electronic Health Records of Patients With Cancer: Systematic Review

“…Recently, several systematic reviews related to EHRs have been published, with particular attention given to the implementation of EHR systems [ 47 , 48 ]. Several studies have discussed different applications of technology to EHRs, such as blockchain [ 49 ]; yet, few have focused on the specific secondary use of EHRs, such as the role in reducing unwarranted clinical variation [ 6 ] and patient identification and clinical support in palliative care [ 50 ], with even fewer focusing on specific disease areas such as diabetes [ 51 ]. There is existing work elucidating the state of AI research in cancers [ 52 , 53 ].…”

“…According to the research objectives, we retrieved the following data from the key information: study details (including title, author, journal, time of publication), EHR details (including data period, data type, number of sources of data, data set size, data set publicly available, language, patient sample size), AI details (including algorithm categories, precision, negative predictive value, sensitivity [recall], specificity, F-score, accuracy, area under the curve [AUC], and applications), and cancer category. The notes were discussed in a consensus meeting between 2 reviewers after they independently retrieved the detailed data about the items, and they were asked to identify possible bias [ 6 , 7 ] in each paper. Publication bias, unblinded trial bias, and time lag bias were identified.…”

Show me the money: how do we justify spending health care dollars on digital health?

“…24,25 Evidence supports Perspectives the use of EMR capabilities such as clinical decision support systems, electronic medication management and digital clinical care pathways to improve care. 15,26 These capabilities are driven by the secondary use of routinely collected clinical data to improve the quality and safety of health care delivery, which has become an important enabler for health care improvement. 27 The impact of EMR implementations over time can be described using a three-horizon conceptual model of digital transformation (Box 2):…”

“…Investments in hospital‐based EMRs are controversial, as they disrupt usual ways of working, can create slower workflows, and have been shown to contribute to clinician frustration and burnout 24,25 . Evidence supports the use of EMR capabilities such as clinical decision support systems, electronic medication management and digital clinical care pathways to improve care 15,26 . These capabilities are driven by the secondary use of routinely collected clinical data to improve the quality and safety of health care delivery, which has become an important enabler for health care improvement 27 …”

Improving compliance with venous thromboembolism prophylaxis guidelines in obese inpatients

“…There is literature to support the use of the electronic medical records (EMR) system in reducing unwarranted clinical variation in acute healthcare and compliance with standards of care. 13,14 EMR provide a means to monitor and address unwanted clinical variation through the provision of clinical decision support, which appears to improve rates of appropriate thromboprophylaxis in a wider inpatient population. 15 The aim of this study was to assess compliance with local hospital VTE prophylaxis guidelines in our network and to identify potential improvement strategies.…”