A review of the empirical evidence of the value of structuring and coding of clinical information within electronic health records for direct patient care

First Review

This is a review of the article by Kalra, et al., A review of the empirical evidence of the value of structuring and coding of clinical information within electronic health records for direct patient care .

Abstract

Although structured and/or coded electronic health records (EHRs) continue to be billed as benefiting direct patient care, the evidence base for this assumption is not well documented.

Methods

The authors interrogated nine international databases from 1990 to 2011. Value was defined using the Institute of Medicine's six areas for improvement for healthcare systems: effectiveness, safety, patient-centredness, timeliness, efficiency and equitability. Included were studies satisfying the Cochrane Effective Practice and Organisation of Care (EPOC) group criteria.

Results

Of 5016 potentially eligible papers, only 13 studies satisfied the authors' criteria: 10 focused on effectiveness, with eight demonstrating potential for improved proxy and actual clinical outcomes if a structured and/or coded EHR was combined with alerting or advisory systems in a focused clinical domain. Three studies demonstrated improvement in safety outcomes. No studies were found reporting value in relation to patient-centredness, timeliness, efficiency or equitability.

Conclusion

The authors concluded that there has been patchy effort to investigate empirically the value from structuring and coding EHRs for direct patient care. Future investments in structuring and coding of EHRs should be informed by robust evidence as to the clinical scenarios in which patient care benefits may be realized.

Comments

This study was conducted in 2012. I would like to see a study with the same focus take place in a hospital setting, with several hospitals being included in the study. If the correlation can be made that structured and coded clinical information on electronic health records improves direct patient care, why is there not more evidence of such?

Second Review

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