Patient history key to proper diagnosis

Aug. 29, 2017
Jamie Clifton, Vice President, Product Management and Solutions, BridgeHead Software

It makes sense to give clinicians the most complete possible access to patient data, test results, past visits and diagnoses, mental health history, and more. However, even the most up-to-date electronic medical record (EMR) system has glaring holes that clinicians struggle to fill. This can result in extra questions for the patient and/or searching through legacy and ancillary records systems such as PACS that aren’t connected to the EMR. That extra time spent searching for patient information is time clinicians aren’t using to make diagnoses or treat other patients.

The patient history is crucial to proper diagnosis, the sole determinant in up to 80% of diagnoses, depending on the study. Clinicians need the most complete patient record in as short a time as possible, which points to the need for an independent clinical archive (ICA), the next-generation version of the vendor neutral archive. An ICA can aggregate historic and referenceable patient data from a wide range of applications—among hospital departments or external healthcare organizations—making that data available to the EMR alongside its current information to inform more accurate decision-making. An ICA can be integrated directly with an EMR, accessed by a clinical portal or viewer, or as part of an integration engine.

Clinicians need actionable information STAT

One might think the advent of advanced diagnostic tools would lessen the need for historical patient information. But research on the issue continues to show the value of patient history in making accurate diagnoses. An analysis of self-report studies discovered a high correlation between history and diagnosis. One study showed that history provided the most important aspect of diagnosis in 56% of cases. Another study showed that patient history was sufficient in 83% of cases to make an initial diagnosis that was later found to agree with the final diagnosis.

Research from Johns Hopkins University showed that more than 40,000 patient deaths in American ICUs can be attributed to misdiagnosis, a number that rivals the country’s 2016 mortality rate from car crashes. Another study linked “system-related factors” such as deficits in process, teamwork, and communications to two-thirds of diagnosis errors.

A multi-institutional project funded by the Agency for Healthcare Research and Quality sums up the challenges facing clinicians in pressure situations: “Critical information can be missed because of failures in history-taking, lack of access to medical records, failures in the transmission of diagnostic test results, or faulty records organization (either paper or electronic) that created problems for quickly reviewing or finding needed information.”

Recommendations from the study include leveraging information technology tools to surmount challenges presented by pitfalls in cognition and care processes. It also points to the need for better ways to streamline the presentation of documentation and the access and display of historical data.

EMRs don’t tell a complete story

When a hospital installs a new EMR, the vendor likely wants to start with the cleanest install possible, which means leaving a lot of patient information behind. One large vendor brings over information about allergies, vaccinations, future appointments, and patient identifiers—but nothing else. Other vendors might allow a year or two of historic patient data but would greatly prefer to migrate as little as possible. Actionable information should transition to the EMR while reference data would be better placed in the ICA.

Depending on the size of a hospital and its uptake of technology, there might be two or more legacy EMR systems that contain patient history information but aren’t readily accessible by clinicians.

Young and relatively healthy patients can likely give their medical history quickly and without incident. But, for many older patients, those with altered mental status and the unresponsive, doctors only have their observations, current test results, and what they can uncover in the EMR to make diagnoses. Time spent wading through multiple legacy systems to track down missing information not only takes time away from diagnosing and treating patients, but it also slows patient throughput and, perhaps, denies care to other patients.

Large urban and safety-net hospitals face additional challenges from the mentally ill, addicts, and those who are drug-seeking. In these cases, knowing more of a patient’s history, including previous visits and potential mental health referrals, can help physicians separate the frequent flyers from those with legitimate medical needs.

In an ideal scenario, a patient’s history would be presented alongside current information in the EMR to complete the patient record and show the physician all he or she needs to see within the confines of the usual workflow.

Simplifying EMR integration with an independent clinical archive

EMR systems aggregate some patient data but remain woefully short of what clinicians would rightly call a complete patient record. Our research shows that:

  • 25% of EMRs cannot access lab results,
  • 33% of EMRs cannot access radiology reports, and
  • 49% of EMRs cannot access patient consent information.

The statistics are even worse for other data types such as mental health notes, ophthalmic data, sleep studies, ultrasound, or nearly any type of historic data.

An independent clinical archive can be the repository for EMR data that didn’t make the transition to the latest system. It also can contain information from other legacy systems that are no longer in active use, allowing them to be retired.

By supporting standard data interfaces, an ICA can be called directly from the EMR to provide supplementary patient information as and when the clinician requires it. Reducing the number of places clinicians need to look for data not only saves them time, it also allows them to focus more squarely on patient care.

Arming providers with the proper tools to make quick, accurate diagnoses help patients receive the right level of care that can speed healing. It also helps speed patient throughput, allowing hospitals to maximize their resources and treat more patients with the same number of personnel.

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