Shea CM, Halladay JR, Reed D, et al. "Integrating a health-related-quality-of-life module within electronic health records: a comparative case study assessing value added."

Reference
Shea CM, Halladay JR, Reed D, et al. Integrating a health-related-quality-of-life module within electronic health records: a comparative case study assessing value added. BMC Health Serv Res 2012 Mar 19;12:67.
Abstract
BACKGROUND: Health information technology (HIT) applications that incorporate point-of-care use of health-related quality of life (HRQL) assessments are believed to promote patient-centered interactions between seriously ill patients and physicians. However, it is unclear how willing primary care providers are to use such HRQL HIT applications. The specific aim of this study was to explore factors that providers consider when assessing the value added of an HRQL application for their geriatric patients. METHODS: Three case studies were developed using the following data sources: baseline surveys with providers and staff, observations of staff and patients, audio recordings of patient-provider interactions, and semi-structured interviews with providers and staff. RESULTS: The primary factors providers considered when assessing value added were whether the HRQL information from the module was (1) duplicative of information gathered via other means during the encounter; (2) specific enough to be useful and/or acted upon, and; (3) useful for enough patients to warrant time spent reviewing it for all geriatric patients. Secondary considerations included level of integration of the HRQL and EHR, impact on nursing workflow, and patient reluctance to provide HRQL information. CONCLUSIONS: Health-related quality of life modules within electronic health record systems offer the potential benefit of improving patient centeredness and quality of care. However, the modules must provide benefits that are substantial and prominent in order for physicians to decide that they are worthwhile and sustainable. Implications of this study for future research include the identification of perceived "costs" as well as a foundation for operationalizing the concept of "usefulness" in the context of such modules. Finally, developers of these modules may need to make their products customizable for practices to account for variation in EHR capabilities and practice workflows.
Objective

To explore factors that primary care providers consider when assessing the value added of an HRQL application for their geriatric patients.

Tools Used
Type Clinic
Primary care
Type Specific
Family practice, geriatrics, and primary care
Size
Small and/or medium
Geography
Urban, suburban, and rural
Other Information
The study involved three primary care practices - 2 small (1-2 providers), independently owned family practices located in small towns. The third was a general internal medicine practice housed within a large academic medical center.
Type of Health IT
Electronic health records (EHR)
Type of Health IT Functions
The Geriatric Enhancement Module (GEM) was developed by a team of university-based health services researchers in collaboration with a private software vendor. It is comprised of a 7-item questionnaire that gathers patient-reported health-related quality of life (HRQL) data about physical health, emotional health, physical functioning and limitations in activities of daily living, and level of social support. The GEM software was designed so that items would be promoted to appear within the EHR during the intake portion of the medical encounter (i.e., when vital signs and chief complaints are recorded by clinical staff) for all patients 50 years and older. Patients viewed and entered answers to the GEM questions directly into the medical record system. During the patient encounter, GEM items were displayed in the EHR for the provider. Patients also could raise issues related to their answers to the GEM questions.
Context or other IT in place
All sites had operational EHRs that could incorporate the Geriatric Enhancement Module (GEM).
Workflow-Related Findings
Consistency of data collection process with nursing workflow contributed to the practice's level of GEM usage and decision to sustain usage.
Study Design
Pre-postintervention (no control group)
Study Participants
Clinical staff at the three practices recruited a sample of 60 patients, approximately 20 from each practice. A total of 16 interviews were conducted with providers and clinical/administrative staff.