Question

In regards to the topic "Does the implementation of health informatics increase the level of care given to patients?"

Design a basic study using either correlation or regression.

How would you conduct the study and why?

What variables would be used and why?

Answer 1

Patient-centered care is an important aspect of high-quality care. Health informatics, particularly advances in technology, has the potential to facilitate, or detract from, patient-centered cancer care. Informatics can provide a mechanism for patients to provide their clinician(s) with critical information, and to share information with family, friends, and other patients. This information may enable patients to exert greater control over their own care. Clinicians may use information systems (e.g., electronic medical records) to coordinate care and share information with other clinicians. Patients and clinicians may use communication tools and information resources to interact with one another in new ways. Caution in using new information resources is warranted to avoid reliance on biased or inappropriate data, and clinicians may need to direct patients to appropriate information resources. Perhaps the greatest challenge for both patients and providers is identifying information that is high-quality and which enhances (and does not impede) their interactions.

Electronic Health Records

The delivery of cancer care, arguably one of the most complex, multidisciplinary, and data-intensive undertakings in all of medicine, is well suited to the wider use of electronic health records (EHRs) to manage oncology data and workflows. Many cancer therapies entail considerable patient morbidity and risk, and the oncology EHR is an important clinical tool to enhance the IOM principles of patient safety, timeliness, and efficiency, as well as patient-centeredness.

Regrettably, oncology care in 2011 is not as safe and evidence-based as it could be. Hospital and office workflows, still largely paper based, contribute to errors such as omissions and duplications that can cause patient harm. Problems include illegible handwriting, computational prescribing errors, inadequate patient hand-offs, and drug administration errors. For example, in a retrospective review of 1262 adult oncology visits across three clinics and 117 pediatric oncology visits in a single clinic, 7.1% and 18.8% of the visits, respectively, were associated with a medication error. Almost 60% of the errors had the potential to cause harm, and in 13% of cases, actual patient harm did result.8 Even when computerized provider order entry (CPOE) systems are utilized, chemotherapy errors are not eliminated. A report from the Dana-Farber Cancer Institute (DFCI) in 2000 showed that 4% of all adult chemotherapy orders written during the time course studied had at least one error.9

EHRs have great potential to minimize common chemotherapy-related errors when designed and implemented according to basic safety principles. The American Society of Clinical Oncology (ASCO) and the Oncology Nursing Society recently published a joint set of 31 safety standards across seven domains to govern the administration of chemotherapy in the outpatient setting.10 While not specific to EHRs, this document informed the creation of the proposed certification criteria for the oncology EHR developed by the Certification Commission for Healthcare Information Technology (CCHIT), currently in draft form.11 Additional principles of safe practice for an oncology CPOE system were published in the Journal of Oncology Practice in 2008, based in part on seminal work on patient safety performed at DFCI.12 These include prohibition of verbal and handwritten orders, standardization of regimens for chemotherapy and supportive medications, automated dosing calculations, and decision support tools to notify users of allergies, drug interactions, and needed dose adjustments.

Patients with cancer should expect that their care is safe and effective. Little is known about oncology patients’ attitudes towards chemotherapy safety principles and practices. One survey performed at a regional Swiss hospital of 479 chemotherapy patients showed that 16% had experienced an error in their care, and over 55% expressed concerns about errors.13 Most of those surveyed agreed that patients can play a role in error prevention; however, only a minority identified that hospital staff actually encouraged them to report errors in care that they might have recognized (e.g., failure of staff to perform appropriate hand hygiene in the patient’s presence). Providers should encourage patient participation in making care safer for oncology patients, and institutions should facilitate patient empowerment by implementing electronic systems to promote communication among providers and between patients and providers, including systems for reporting errors.

Cancer patients in particular have high information needs, and these might be well-served by interaction with an EHR14 by, for example, using a patient portal, as discussed below. Even at the level of a single provider and patient, there are opportunities to integrate the EHR more fully into the visit as an enabler of patient-centered care and a communication tool. While EHRs are largely used today to store and transfer patient data and document visits for purposes of reimbursement, they could more effectively be used at the point of care in the exam room to educate patients (e.g., viewing imaging studies together), to engage them in co-creation of visit notes, and to enlist them in ensuring the accuracy of the data being recorded.15 It should be noted that the high cost of EHRs can be a critical barrier to adoption of these systems.