Background: The case has historically been presented that structured and/or coded electronic health records (EHRs) benefit direct patient care, but the evidence base for this is not well documented.
Methods: We searched for evidence of direct patient care value from the use of structured and/ or coded information within EHRs. We interrogated nine international databases from 1990 to 2011. Value was defined using the Institute of Medicine's six areas for improvement for healthcare systems: effectiveness, safety, patient-centredness, timeliness, efficiency and equitability. We included studies satisfying the Cochrane Effective Practice and Organisation of Care (EPOC) group criteria.
Results: Of 5016 potentially eligible papers, 13 studies satisfied our criteria: 10 focused on effectiveness, with eight demonstrating potential for improved proxy and actual clinical outcomes if a structured and/or coded EHR was combined with alerting or advisory systems in a focused clinical domain. Three studies demonstrated improvement in safety outcomes. No studies were found reporting value in relation to patient-centredness, timeliness, efficiency or equitability.
Conclusions: We conclude that, to date, there has been patchy effort to investigate empirically the value from structuring and coding EHRs for direct patient care. Future investments in structuring and coding of EHRs should be informed by robust evidence as to the clinical scenarios in which patient care benefits may be realised.
This work was funded by the English National Health Service (NHS) Connecting for Health Evaluation Programme (NHS CFHEP 009). The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NHS CFHEP or the UK Government Department of Health.
We gratefully acknowledge the advice on this research, which has been provided by members of the Independent Project Steering Committee overseeing our programme of work into the structuring and/or coding of the clinical record. Chaired by Professor Simon de Lusignan, this group also comprises Dr Nick Booth, Dr Stephen Kay and Lee Priest.
- Clinical coding
- Clinical outcomes
- Electronic health records
- Health information technology
- Structured data entry