Electronic health records as a catalyst for improving quality and safety of care

Organizer:
Ethical, Legal and Social Issues (ELSI) Working Group of the American Medical Informatics Association (AMIA)

Panelists:
Traber Davis Giardina, PhD, MSW (Assistant Professor, Baylor College of Medicine; Researcher, Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center)
Julia Adler-Milstein, PhD (Professor, UCSF School of Medicine; Director, Center for Clinical Informatics and Improvement Research, UCSF)
Sharon Moon, JD, MPopH (Former Senior Associate Director of Quality and Patient Safety; Steering Committee, Right Care Alliance)
Jodyn Platt, MPH, PhD (Assistant Professor, University of Michigan Medical School)



ELSI Working Group representatives:
Richard Schreiber, MD (Associate Chief Medical Informatics Officer, Penn State Health Holy Spirit Medical Center)
Mia Schultz, BSN, RN (Clinical Information Systems Specialist, The Osborn)



Overall points from discussion:
As a first step to being useful, data needs to be correct and reasonably complete
EHE data is expected to fulfill many tasks — patient care, billing, quality improvement, research, public health
Need not just to have data, but to turn data into meaning

Issues at personal scale:
Variability in patient needs/desire for data
Data is recorded in a way that is designed for understanding by clinicians, not patients
Current systems can perform well for delivering simple information (such as result of COVID test), but not well-suited for longitudinal data to help people make health decisions

Issues at organizational scale:
May be "drowning in data" — Need better process of question asking and matching data to answer those questions
Who should be analyzing data? — Need a dedicated analyst.
Why should data be analyzed? —To maximize billing? To identify patient harm?

Issues at system-wide and population scale:
Tension between need for customized data and need for standards to allow data comparison and integration
Patients moving between different facilities may not have access to data from previous facility