Summary
Objective: To support collaboration and clinician-targeted decision support, electronic health
records (EHRs) must contain accurate information about patients’ care providers. The
objective of this study was to evaluate two approaches for care provider identification
employed within a commercial EHR at a large academic medical center.
Methods: We performed a retrospective review of EHR data for 121 patients in two cardiology
wards during a four-week period. System audit logs of chart accesses were analyzed
to identify the clinicians who were likely participating in the patients’ hospital
care. The audit log data were compared with two functions in the EHR for documenting
care team membership: 1) a vendor-supplied module called “Care Providers”, and 2)
a custom “Designate Provider” order that was created primarily to improve accuracy
of the attending physician of record documentation.
Results: For patients with a 3–5 day hospital stay, an average of 30.8 clinicians accessed
the electronic chart, including 10.2 nurses, 1.4 attending physicians, 2.3 residents,
and 5.4 physician assistants. The Care Providers module identified 2.7 clinicians/patient
(1.8 attending physicians and 0.9 nurses). The Designate Provider order identified
2.1 clinicians/patient (1.1 attending physicians, 0.2 resident physicians, and 0.8
physician assistants). Information about other members of patients’ care teams (social
workers, dietitians, pharmacists, etc.) was absent.
Conclusions: The two methods for specifying care team information failed to identify numerous
individuals involved in patients’ care, suggesting that commercial EHRs may not provide
adequate tools for care team designation. Improvements to EHR tools could foster greater
collaboration among care teams and reduce communication-related risks to patient safety.
Keywords
Provider communication - care team - electronic health records - health information
technology - patient care team
