Industry Insight

Canadian Study Touts Benefits of Ambulatory EMRs

EMR use in ambulatory care, along with complementary technologies, is yielding health system and patient benefits such as improved patient safety, continuity of care, and clinic efficiency, according to a new study.

The Infoway-commissioned “Emerging Benefits of EMR Use in Ambulatory Care in Canada: Benefits Evaluation Study” also points to more upside potential with advanced use and continued EMR adoption in ambulatory care settings. Authored by PricewaterhouseCoopers (PwC), the study drew on more than 200 research publications, as well as recent Canadian research and reports and key informant interviews.

“Interoperable EMRs are an important tool in supporting coordination and quality of care between hospital-based ambulatory clinics and other care settings,” explains Michael Green, president and CEO of Canada Health Infoway. “Health system and patient benefits from ambulatory care EMR use are valued at $200 million and enhanced system efficiencies enabled 1.2 million more patient visits in 2015 alone.”

Study highlights include the following:

• Fifty-seven percent of EMR-enabled clinics reported that EMR use had been beneficial for improving quality of care. Clinics with access to external data sources (66%), those using more advanced functions (74%), and those that transitioned to a fully paperless environment (87%) were more likely to report EMR use had a positive impact on improving quality of care.
• An estimated $200 million in annual value was realized in 2015: $95 million from reduced clinician time spent on chart management processes, $46 million from avoided duplicate laboratory tests and $37 million from avoided duplicate diagnostic tests, $13 million from reduced hospitalizations due to adverse drug events, and $4 million realized by patients when availability of required heath information avoided unnecessary delays in care.
• Approximately 1.2 million additional patient visits occurred in 2015, resulting from enhanced clinic efficiency.
• The report includes a special focus highlighting the specific values in outpatient cancer care, which include 201,000 estimated fewer days patients spent waiting from consultation to first treatment, 15,500 additional radiation therapy treatments, and 4,000 additional systemic therapy treatments.

“When ambulatory EMRs are used with complementary technologies such as decision support and comprehensive medication profiles across settings, they help reduce adverse drug events, leading to fewer emergency department visits and hospitalizations,” Green explains.

The study also outlines the most common barriers to realizing benefits such as mixed paper/electronic systems, multiple logins, system design and functionality gaps, misalignments with clinical requirements and workflow, and a lack of available equipment.

“The use of EMRs in ambulatory care is still relatively new, and there is potential for even greater benefits with increased adoption,” Green continues. “With approximately 45 million ambulatory care visits in Canada in 2014, the potential benefits for patients, specialists, and the health care system is significant.”

The full study document includes a core set of recommendations, priority research areas, and critical success factors for future implementations.

In partnership with hospital organizations and the provinces and territories, Infoway’s investments included 22 ambulatory care EMR implementation projects impacting approximately 25,000 clinicians in nine provinces.

— Source: Canada Health Infoway

Researchers Question Veracity
of Online Pancreatic Cancer Information

The internet has become a powerful and important resource for daily life. When patients receive a medical diagnosis, particularly a difficult one like pancreatic cancer, the web can be an essential information tool, helping to enable patients to have meaningful discussions with health care providers. However, new research from Beth Israel Deaconess Medical Center (BIDMC) recently published in JAMA Surgery suggests that online information about pancreatic cancer is often written at a prohibitively high reading level and lacks accuracy concerning alternative therapies.

“We know from past research that people are strongly influenced by what they read online, and they believe that what they read on the internet will help them make better health care decisions,” says senior author Tara Kent, MD, a pancreatic surgeon at BIDMC and an assistant professor of surgery at Harvard Medical School. “Dealing with a diagnosis of pancreatic cancer is difficult enough without asking patients to negotiate PhD-level terms. The concern here is that available web information may, in fact, be adding to existing barriers to care. If patients don’t understand what they’re reading, how can they make the best decisions about treatment options?”

The degree to which patients are empowered by written educational materials depends on the text’s readability level and the accuracy of the information provided. A patient’s health literacy or ability to comprehend written health information can impact clinical outcomes. Reading materials are rarely written at the sixth- to seventh-grade reading level recommended by literacy specialists and multiple national institutions.

Kent and colleagues compared the accuracy and readability of patient-oriented online resources for pancreatic cancer by treatment method and website affiliation, such as privately owned, media, academic, or government websites. The researchers conducted an online search of 50 websites discussing five pancreatic cancer treatment methods (alternative therapy, chemotherapy, clinical trials, radiation therapy, and surgery). Readability was measured by nine standardized tests, and accuracy was assessed by an expert panel.

“We found that the median readability level was higher than recommended, requiring at least 13 years of education to be comprehended, but only 58% of the adult US population has attained this level of education,” Kent says. “These data indicate that online information about pancreatic cancer is geared to more educated groups. The general population and vulnerable groups—particularly those with low health literacy—will likely struggle to understand this information.”

The authors also found appreciable differences among website affiliations and among websites discussing treatment methods. Those discussing surgery were easier to read than those discussing radiotherapy and clinical trials. Websites of nonprofit organizations were easier to read than media and academic websites. Nonprofit, academic, and government websites had the highest accuracy, particularly those relating to clinical trials and radiotherapy. Alternative therapy websites exhibited the lowest accuracy scores. Websites with higher accuracy were more difficult to read than websites with lower accuracy.

“This research illustrates one of the challenges incurred in the creation of accurate, yet understandable online information about a complex disease and its treatment options,” the authors wrote. “In the absence of an internet librarian, health care professionals should acknowledge that online information on aggressive diseases such as pancreatic cancer could be misleading and potentially harmful, and they should assume an active role in the evaluation and recommendation of online resources.”

“Addressing the issue of equitable health literacy is especially critical as we work to close gaps in care among all the communities we serve, and as we continue to work toward empowering patients in the shared decision-making process,” Kent says.

— Source: Beth Israel Deaconess Medical Center