View source for Electronic medical records and quality of cancer care

This is a review of a 2014 article by Klumpp,T.R. entitled; Electronic Medical Records and Quality of Cancer Care <ref name= "Klumpp2013">Klumpp, T. R. (2013). Electronic Medical Records and Quality of Cancer Care. Current Oncology Reports, 15(6), 588–594. doi:10.1007/s11912-013-0347-z</ref>


==Introduction ==
The author notes that although the [http://www.iom.edu/About-IOM.aspx Institute of Medicine (IOM)] recommended the use of Electronic Medical Records ([[EMR]]) in clinical settings to aid in reduction of preventable deaths due to lack of pertinent information <ref name = "IOM">Institute of Medicine (US) Committee on Quality of Health Care in America. (2000). To Err is Human: Building a Safer Health System. (L. T. Kohn, J. M. Corrigan, & M. S. Donaldson, Eds.). Washington (DC): National Academies Press (US). Retrieved February 28th 2015 from http://www.ncbi.nlm.nih.gov/books/NBK225182/</ref>, many physicians had disagreeing experiences. The author states that ''nearly all physicians'' have noted ''significant imperfections '' in EMR systems and are skeptical as to the ability of these systems to improve clinical outcomes.  The author also brings into question the risk benefit ratio of EMR systems as a whole <ref name = "Klumpp2013"/> 


==Methodology ==
Although the methodology is not implicitly stated it appears that is is based on review of ''supportive'' literature and anecdotal / experiential accounts of physicians. 

==Observation==
===Potential Benefits of EMR Systems===
*Improve the quality of clinical decisions due to readily available patient information that is legible.
*Clinical Decision support alerts for contraindication of drugs for a number of reasons - including prior patient history of a drug reaction.
*Improved health data exchange between Institutions and Healthcare providers for comparison of outcomes or for coordinating patient care.
*Improved communication between physicians and patients.

===Risks Associated with EMR Systems===
The author breaks down risks into four categories as noted by clinicians and summarized below:
# ''Interference with the flow of data to clinicians''
#*Clinicians have reported being inundated by CDS system with information that is time consuming to wade through and does not inform clinical decison making.
#* Searching through ''Silos'' to find relevant information for clinical decisions is time consuming
#*Suboptimal presentation of EMR generated clinical oncology patient flowsheets in comparsison to paper systems
#*Physicians resorting to documenting both in the EMR and on paper
#''Direct predisposition to medication errors''
#*Formatting of prescription lists generated from ([[CPOE]]) could be misleading and cause errors.
#*Unintentional discontinuation of needed patient medication
# Decreased time spent with patients
#*Increased EMR documentation time detracting from time spent with patients
#''Active incentivization of clinicians and/or hospitals to provide suboptimal care"
#*''Pay for performance" EMR programs may be costly will not necessarily provide quality of care

==Discussion ==
The author finds little benefit to be afforded by the use of EMR systems and concludes that they do not appear to be cost effective in improving clinical outcomes based on review of the literature and experiential accounts.

==Conclusion == 
The review appears slanted towards the potential ''risks'' of EMR implementation on quality of patient care. The article does not give details regarding the clinical settings in which the setbacks with EMR systems were encountered or details regarding the type of EMR used.  It is unclear if the EMR's in question were home-grown systems or commercially available. The level of prior expertise and subsequent EMR training received prior to implementation is also unknown.   Given the slant of the article it is plausible that key stakeholders among the clinicians may not have been adequately involved in the development and or implementation of the EMR /CDS systems. It is also unknown if clinical workflow was taken into account during the process of implementation. The author makes several generalizations alluding to what is perceived to be the common impression among clinicians who have used EMR systems. Although the word "Evidence" is mentioned numerous times in the article it is my impression that this was not a systematic review of existing literature on EMR ability to facilitate clinical decision support ultimately enhancing patient care. The journal of Implemenation Science website has a collection of systematic review studies that examine the effectiveness of computerized clinical decision support systems in improving clinical outcomes<ref name = "SystematicReview2011">Journal of Implementation Science CDSS collecton http://www.implementationscience.com/series/CCDSS</ref>. The author could have lent more credence to the article observations by using similar methodology in the literature review.

== Related Articles ==

Understanding missed opportunities for more timely diagnosis of cancer in symptomatic patients after presentation <ref name= "Lyratzopoulos G">Lyratzopoulos G et al. Understanding missed opportunities for more timely diagnosis of cancer in symptomatic patients after presentation. Prim Health Care Res Dev. 2015 3:1-8</ref>

Embedding electronic decision-support tools for suspected cancer in primary care: a qualitative study of GPs' experiences. <ref name= "Dikomitis L ">Dikomitis L et al. Embedding electronic decision-support tools for suspected cancer in primary care: a qualitative study of GPs' experiences. Br J Cancer. 2015:47</ref>


== References ==
<references/>


[[Category:Reviews]]
[[Category:EMR]]
[[Category:Usability]]
[[Category:CDS]]