Society of Hospital Medicine: 2013 RIV Abstract Issue, Volume 8,
May 2013 Abstract Supplement
Society of Hospital Medicine: 2013 Abstracts
National Harbor,Maryland May 16-19, 2013.
ATTENDING USE OF THE ELECTRONIC HEALTH RECORD AND IMPLICATIONS FOR HOUSE-STAFF SUPERVISION: PRELIMINARY RESULTS FROM A MIXED-METHODS STUDY
Kiara Tulla 1 , Shannon Martin 2 , David Meltzer 3 , Vineet Arora 4 , Jeanne Farnan 5
With current health information technology, the electronic health record (EHR) is accessible to review clinical information from remote locations. Although patterns of remote EHR access by residents have been described, little information exists regarding how attendings are using the EHR away from the hospital. We hypothesized that attendings may be using the EHR as a means to provide clinical oversight to house staff. We aimed to assess how attending physicians are using the EHR remotely, with special attention to how they may use it to provide supervision to trainees.
Attendings on the general medicine teaching service for 2–4 weeks at a single institution from January to November 2012 were contacted for participation. Participants were consented and privately interviewed and surveyed regarding use of the EHR. Descriptive statistics were obtained for preliminary analysis. Interview transcripts were reviewed in anticipation of qualitative analysis to follow.
Response rate was 83% (59 of 71). Among general medicine inpatient attendings, 97% reported using the EHR from home. More than 70% of attendings spent at least 60–90 minutes daily in total using the EHR and at least 30–60 minutes using it remotely. The EHR was most commonly accessed remotely for signing notes (88%), monitoring vital signs and test results (83%), reviewing consultant notes (76%), and reviewing past history (59%). With respect to clinical oversight, 93% used the EHR to confirm clinical information received by house staff, and 54% reported this frequently (i.e., at least 3 times per week). Eighty-nine percent had discovered information on personal review of EHR that house staff had not relayed adequately, with 33% noting this frequently. With respect to actions taken due to EHR oversight, 93% reported changes in management as a result of these discoveries, with 20% noting this frequently. Nearly all attendings reported management changes the following day because of viewing the EHR from home (52% frequently), and 54% had management changes at the time of reviewing the EHR from home via immediate communication to house staff (13% frequently). Although formal qualitative analysis of attending interviews is pending, common reasons for remote access of the EHR such as patient safety and house staff trust have emerged on preliminary review; 1 attending stated, “I'm there as a check — I think we're all there to serve as a little bit of a safety net for patients, and EHR has made that so much easier.”
Attendings commonly access the EHR remotely and report a high frequency of electronic oversight supervision, including confirmation of clinical data. Discovery of information not adequately relayed by house staff often occurs, as do attending-driven changes in management as a result of these discoveries. It will be important to understand implications of this practice for house staff autonomy and attending provision of supervision, and future qualitative work will more closely examine motivating factors behind attending EHR use.Author Disclosure: Shannon K. Martin, none; Kiara Tulla, none; David O. Meltzer, none; Vineet M. Arora, none; Jeanne M. Farnan, none.
To cite this abstract, please use the following information:
Tulla Kiara,Martin Shannon,Meltzer David,Arora Vineet,Farnan Jeanne; ATTENDING USE OF THE ELECTRONIC HEALTH RECORD AND IMPLICATIONS FOR HOUSE-STAFF SUPERVISION: PRELIMINARY RESULTS FROM A MIXED-METHODS STUDY [abstract]. Journal of Hospital Medicine 8 Suppl 1 :620