Unintended adverse consequences of introducing electronic health records in residential aged care homes

Abstract

Although the benefits of the EHR systems were obvious, as found by our previous study, introducing EHR systems in RACH can also cause adverse consequences of EHR avoidance, difficulty in access, increased complexity in information management, increased documentation burden, reduction of communication and the risks of lacking care follow-up, which may cause negative effects on aged care services. Further research can focus on investigating how the unintended adverse consequences can be mitigated or eliminated by understanding more about nursing staff's work as well as the information flow in RACH. This will help to improve the design, introduction and management of EHR systems in this setting.

Antecedents for safety in health IT: An exploratory investigation

“…The data collection was conducted in hospital or at clinical sites for most of the studies. [5] • Video observation 10 medicine physicians Not stated [9] • Interview • Observation 20 pharmacist 5 pharmacies [12] • Document analysis 116 records Not stated [13] • Case study Not stated Hospital: Emergency department [14] • Document analysis 484 reports Not stated [15] • Interview 110 care staff members 9 residential aged care homes [16] • User testing • Interview • Observation 92 3 rd and 4 th year dental students 2 clinical sites [17] • Observations • Interviews 9 internal medicine faculty members Academic-affiliated ambulatory care clinic from [18] • Observations • Interviews 16 healthcare worker 9 specialty clinics and 3 primary care clinics [19] • Questionnaire 3929 physicians Healthcare centers, public secondary and tertiary care hospitals [20] • [20]…”

“…Additionally, the scope and content of the electronic form were found to be poorly designed to allow user to enter comprehensive information. Some related information had to be entered into a separate screen of the health IT system, which was illogical and inconvenient [15].…”

“…Alternatively, they resort to the convention way of handwritten and subsequently transcribed to their computer when they return to their workstation [13] contributing to the possibility of transcribing wrong information. With the shortage of computer also prohibit the doctors or nurses to enter the report in a timely fashion [15]. Other hardware failure such as power outages, internet access problem and hardware malfunction were also related to the hardware availability problem [12].…”

“…Paper persistence is one of the reasons for the workaround. A user might not aware the updated follow up plan has been made on the health IT system, therefore follow up the wrong care services because he accessed out-of-date hardcopy care plans [15].…”

The Impact of Electronic Health Records on Risk Management of Information Systems in Australian Residential Aged Care Homes

“…Unintended adverse consequences included difficulties for some staff in data entry and information retrieval, resistance to using the system, increased complexity of information management, and end user concerns about access. Reasons included the nature of the EHR systems and the ways the systems were implemented and used by nursing staff [13].…”