Ehealth technologies can improve patient care, lower costs, increase efficiency and prevent duplicated tests in Australian hospitals but they risk causing “alert fatigue” and prescription errors, according to new research published in Australian Health Review.
Conducted by a team of authors involved in the digitisation of Brisbane’s Princess Alexandra Hospital, Going digital: a narrative overview of the clinical and organisational impacts of eHealth technologies in hospital practice claims ehealth systems can improve healthcare processes and patient outcomes but much is still to be learned about best practice design and use.
The study by PAH and Queensland’s Metro South Hospital and Health Service evaluated recently published research reviews of electronic medical records, electronic prescribing, computerised decision support systems and computerised physician order entry technologies, and found the benefits outweighed the risks.
The technologies could bring about greater guideline adherence, eliminate illegible handwriting, improve information transfer and lead to reduced hospitalisations, emergency visits and redundant test requests, the research found. But they could also lead to increased technology interaction time for clinicians and alert fatigue, as well as prescribing errors causing adverse drug-related events.
The study found:
EMRs have the potential to increase the accuracy and completeness of clinical information and to reduce documentation time. Improvements in information transfer and organisational efficiency may translate into reduced hospitalisations, emergency visits and redundant test requests.
CPOE appears to improve laboratory turnaround times, which is offset by increased interaction times, workflow interruptions and workarounds.
Eprescribing significantly reduces medication errors and adverse drug events and may further increase patient safety and organisational efficiency with reminders relating to significant drug interactions that may otherwise be missed. Eliminating illegible handwriting and inappropriate dose prescribing by physicians, and improving communication with pharmacists are proven benefits. However, there is potential for alert fatigue, and duplication or wrong selection of medication type and dosage.
Evidence for improving processes and quality of care that affect clinical outcomes is strongest for CDSS, especially those used at the point of care and integrated well into workflows. These systems substantially increase clinician adherence to guidelines, appropriateness of disease and treatment monitoring, and optimal use of medications. But the customising of the applications to suit patient-centred care and the management of highly complex patients with multi-morbidity is a challenge.
Considerable financial investment is being made globally in the implementation of “potentially transformative ehealth technologies,” according to the research, including £12.8 billion by the UK’s National Program for Information Technology (NPfIT) for the National Health Service. Queensland is following suit with its $1.3 billion statewide campaign to digitise all its major public hospitals by 2020.
The authors claim their study helped gain hospital-wide acceptance for the major transformational change achieved at PAH, where the digital implementation attained HIMSS EMRAM Stage 6.
But as digital healthcare revolutionises the field, they have called for more research into what is an evolving area of study.
“More rigorous field research targeting hospitals undergoing digital transformation, and performed by independent, multidisciplinary research groups, is required to narrow the gap between theorised potential benefits of ehealth technologies and empirically demonstrated real-world improvements in patient care and outcomes and efficient use of resources.”
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