Question

describe the strategies for evaluating the effectiveness of electronic health records

Answer 1

Electronic health records are increasingly being used to facilitate referral communication in the outpatient setting. However, despite support from technology, referral communication between primary care providers and specialists is often unsatisfactory and is unable to eliminate care delays.

Strategies for evaluating the effectiveness of electronic health records:

1. Include real-time clinician-to-clinician communication features as part of the referral system: Providers often prefer traditional face-to-face or synchronous communication, such as telephone conversations. While excessive reliance on the EHR and other health information technology may diminish the use of real-time communication, certain critical situations require the interactivity afforded by direct conversation.

2. Design and use standardized electronic referral templates that include both structured and free-text fields: The content, form, and style of referral letters influence the referral process. Several studies have shown increased provider satisfaction and more consistent and timely feedback from specialists when referral templates are used to standardize referral communication

3. Enforce electronic capture of the reason for the referral: The inclusion of a clear reason to justify a referral is not only regarded as a good professional practice but it has also been shown to expedite the referral process. Therefore, electronic systems should be designed to prevent referrals from being transmitted unless they have a clearly defined reason to justify them.

4. Bring PCPs and specialists together to collaboratively develop referral guidelines for inclusion into the electronic referral system: EHRs offer a robust platform for integrating referral guidelines into providers’ workflows at the point of care, and referral guidelines can improve the referral process in several ways. For instance, they can help providers determine the appropriateness of referral prior to initiating the request or allow a provider to anticipate the specialist’s referral information and patient work-up needs, improving efficiency and quality. People comprise one of the key dimensions of the socio-technical model.

5. Integrate patient communication into the electronic referral process: In recent years, the growth of personal health records and other consumer electronic communication tools have modernized and fundamentally transformed patient-provider communication. Nevertheless, patient-related communication remains vulnerable to breakdowns.

6. Use automation to pre-populate electronic referral requests with patient-specific data:If used appropriately, electronic referrals have the potential to enhance provider workflow by automating certain tedious or repetitive steps where manual effort is unnecessary. The cognitive load imposed by the use of structured templates, referral guidelines, and the use of computerized interfaces increases the time commitment and complexity of initiating and managing referrals.

7. Include the capability of electronic consultations (information-only referrals): The conceptual definition of “referral” implies an actual transfer of responsibility for some aspect of the patient’s care and an encounter with another provider. In contrast, a strict consultation involves seeking a colleague’s opinion about a particular aspect of the care of the patient, but at no time is the patient under the direct care of the consultant.

8. Close the communication loop by providing and integrating referral status tracking and feedback capabilities into providers’ workflows: Coordination of care is more effective when all interested parties are aware of the status of the referral request. Referring providers should receive timely feedback from the specialists upon denial, approval, or completion of each referral. However, studies suggest that specialists fail to provide feedback in 15-45% of referrals. Similarly, specialists may need to discuss requests with the referring providers before or after approving them. In engineering, a closed-loop control system is one in which feedback is needed to control the states or outputs of a dynamic system.

9. Standardize and maintain up-to-date institutional policies and procedures for electronic referrals: Within institutions, lack of clear policies and procedures can result in unnecessary heterogeneity across referral processes causing inefficiencies in inpatient care, provider dissatisfaction, and potential for delays in diagnosis and treatment [9]. Even when organizations develop policies and procedures governing referrals, the adoption of health information technology often translates into profound changes in performance and culture

10. Monitor electronic referral communication performance: As with any health information technology-related process, referral communication should be monitored and revised, as needed, to ensure that all stakeholders’ needs are being met in a safe and efficient manner. For instance, in our previous work, we found that about 7% of electronic referrals at our institution had no follow-up action by specialists at 30 days .