Abstract
Background: Patients who require care by multiple clinicians are at risk for problems during these transitions. Use of an electronic health record (EHR) could provide clinicians a mechanism to coordinate activities and information, thereby improving care across transitions. We examined the impact of having EHR on the availability and timeliness of clinical information within an integrated delivery system.
Population: All adult primary care clinicians (n=396 PCs) working in a large prepaid, integrated delivery system who completed the surveys in both 2005 and 2006. Overall, 57.3% were female, 48.9% were white, 83.1% were physicians, mean age was 45 years, and the mean panel size was 1540 patients. In 2005 only 2.0% of respondents had finished implementing the EHR at the time of their survey versus 39.4% in 2006.
Methods: Using survey data collected in both 2005 and 2006, we examined clinician reports of the availability and timeliness of relevant clinical information when multiple clinicians are involved with their patients’ care. We collapsed the five-point responses into two categories, e.g., high availability when the information was ‘always’ or ‘usually’ available. We defined EHR status as pre-, during, or post-implementation using the implementation dates for the medical center. Using multivariate logistic regression, adjusting for clustering by clinician, medical center, year, clinician gender, race, panel size, job title and status, we examined the association between EHR status and both clinical information availability and timeliness.
Results: In year-one, 42.7% of PCs reported having high levels of clinical information availability, compared with 64.9% in year-two; 39.3% and 62.4% reported having high levels of timely information in years one and two, respectively. Overall, 35.3% and 57.8% reported having high levels of both information availability and timeliness in years one and two, respectively. After adjustment, clinicians working in medical centers that had completed the EHR implementation were significantly more likely to report having high levels of both clinical information availability and timeliness (OR=2.88; 95% CI, 1.46–5.69).
Conclusion: EHRs could be an important tool for improving the timeliness and availability of clinical information. These improvements could facilitate the coordination of care between clinicians.
- Received September 11, 2008.
