Appl Clin Inform 2012; 03(01): 80-93
DOI: 10.1055/s-0037-1618556
Research Article
Schattauer GmbH

Clinical Summarization Capabilities of Commercially-available and Internally-developed Electronic Health Records

A. Laxmisan
1   Houston VA Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center and Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX
,
A.B. McCoy
2   School of Biomedical Informatics, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX
,
A. Wright
3   Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
,
D.F. Sittig
2   School of Biomedical Informatics, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX
› Author Affiliations
Further Information

Publication History

received: 08 November 2011

accepted: 14 February 2012

Publication Date:
16 December 2017 (online)

Summary

Objective: Clinical summarization, the process by which relevant patient information is electronically summarized and presented at the point of care, is of increasing importance given the increasing volume of clinical data in electronic health record systems (EHRs). There is a paucity of research on electronic clinical summarization, including the capabilities of currently available EHR systems.

Methods: We compared different aspects of general clinical summary screens used in twelve different EHR systems using a previously described conceptual model: AORTIS (Aggregation, Organization, Reduction, Interpretation and Synthesis).

Results: We found a wide variation in the EHRs’ summarization capabilities: all systems were capable of simple aggregation and organization of limited clinical content, but only one demonstrated an ability to synthesize information from the data.

Conclusion: Improvement of the clinical summary screen functionality for currently available EHRs is necessary. Further research should identify strategies and methods for creating easy to use, well-designed clinical summary screens that aggregate, organize and reduce all pertinent patient information as well as provide clinical interpretations and synthesis as required.

 
  • References

  • 1 Adler-Milstein J, DesRoches CM, Jha AK. Health information exchange among US hospitals. Am J Manag Care 2011; 17 (Suppl. 11) 761-768.
  • 2 Sittig DF, Singh H. Legal, ethical, and financial dilemmas in electronic health record adoption and use. Pediatrics 2011; 127: e1042-e1047.
  • 3 Gilchrist V, McCord G, Schrop SL, King BD, McCormick KF, Oprandi AM. et al. Physician activities during time out of the examination room. Ann Fam Med 2005; 3: 494-499.
  • 4 Laxmisan A, Hakimzada F, Sayan OR, Green RA, Zhang J, Patel VL. The multitasking clinician: decision-making and cognitive demand during and after team handoffs in emergency care. Int J Med Inform 2007; 76: 801-811.
  • 5 Weigl M, Muller A, Zupanc A, Angerer P. Participant observation of time allocation, direct patient contact and simultaneous activities in hospital physicians. BMC Health Serv Res 2009; 9: 110.
  • 6 Sittig DF, Wright A, Osheroff JA, Middleton B, Teich JM, Ash JS. et al. Grand challenges in clinical decision support. J Biomed Inform 2008; 41: 387-392.
  • 7 Gaylin DS, Moiduddin A, Mohamoud S, Lundeen K, Kelly JA. Public Attitudes about health information technology, and its relationship to health care quality, costs, and privacy. Health Serv Res. 2011
  • 8 Boonstra A, Broekhuis M. Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions. BMC Health Serv Res 2010; 10: 231.
  • 9 Ash JS, Berg M, Coiera E. Some unintended consequences of information technology in health care: the nature of patient care information system-related errors. J Am Med Inform Assoc 2004; 11: 104-112.
  • 10 Weir CR, Nebeker JR. Critical issues in an electronic documentation system. AMIA Annu Symp Proc 2007: 786-790.
  • 11 Staggers N, Clark L, Blaz JW, Kapsandoy S. Why patient summaries in electronic health records do not provide the cognitive support necessary for nurses’ handoffs on medical and surgical units: insights from interviews and observations. Health Informatics J 2011; 17 (03) 209-223.
  • 12 NIST Health IT Standards and Testing [Internet]. Clinical Summaries; Available from: http://healthcare.nist.gov/
  • 13 HL7 Implementation Guide. CDA Release 2 –Continuity of Care Document (CCD). Ann Arbor, Mich:: Health Level Seven, Inc;. Jan, 2007.
  • 14 Wright A, Chen ES, Maloney FL. An automated technique for identifying associations between medications, laboratory results and problems. J Biomed Inform 2010; 43 (06) 891-901.
  • 15 Sittig DF, Singh H. Rights and responsibilities of electronic health record users. CMAJ. 2012 (in press).
  • 16 McCoy AB, Wright A, Laxmisan A, Singh H, Sittig DF. A prototype knowledge base and SMART app to facilitate organization of patient medications by clinical problems. AMIA Annu Symp Proc 2011: 888-894.
  • 17 Greenhalgh T, Wood GW, Bratan T, Stramer K, Hinder S. Patients’ attitudes to the summary care record and HealthSpace: qualitative study. BMJ 2008; 336 7656 1290-1295.
  • 18 Wright A, Sittig DF, Ash JS, Feblowitz J, Meltzer S, McMullen C, Guappone K, Carpenter J, Richardson J, Simonaitis L, Evans RS, Nichol WP, Middleton B. Development and evaluation of a comprehensive clinical decision support taxonomy: comparison of front-end tools in commercial and internally developed electronic health record systems. J Am Med Inform Assoc 2011; 18 (03) 232-242.
  • 19 Petersen LA, Orav EJ, Teich JM, O’Neil AC, Brennan TA. Using a computerized sign-out program to improve continuity of inpatient care and prevent adverse events. Jt Comm J Qual Improv 1998; 24: 77-87.
  • 20 Patterson ES, Roth EM, Woods DD, Chow R, Gomes JO. Handoff strategies in settings with high consequences for failure: lessons for health care operations. Int J Qual Health Care 2004; 16 (02) 125-132.
  • 21 van Walraven C, Rokosh E. What is necessary for high-quality discharge summaries?. Am J Med Qual 1999; 14: 160-169.
  • 22 Green EH, Hershman W, DeCherrie L, Greenwald J, Torres-Finnerty N, Wahi-Gururaj S. Developing and implementing universal guidelines for oral patient presentation skills. Teach Learn Med 2005; 17: 263-267.
  • 23 Onishi H. Role of case presentation for teaching and learning activities. Kaohsiung J Med Sci 2008; 24: 356-360.
  • 24 Van Vleck TT, Stein DM, Stetson PD, Johnson SB. Assessing data relevance for automated generation of a clinical summary. AMIA Annu Symp Proc 2007: 761-765.
  • 25 Law AS, Freer Y, Hunter J, Logie RH, McIntosh N, Quinn J. A comparison of graphical and textual presentations of time series data to support medical decision making in the neonatal intensive care unit. J Clin Monit Comput 2005; 19: 183-194.
  • 26 Hunter J, Freer Y, Gatt A, Logie R, McIntosh N, van der Meulen M. et al. Summarising complex ICU data in natural language. AMIA Annu Symp Proc 2008: 323-327.
  • 27 Greenhalgh T, Stramer K, Bratan T, Byrne E, Russell J, Potts HW. Adoption and non-adoption of a shared electronic summary record in England: a mixed-method case study. BMJ 2010; 340: c3111.
  • 28 Brennecke T, Michalowski L, Bergmann J, Bott OJ, Elwert A, Haux R. et al. On feasibility and benefits of patient care summaries based on claims data. Stud Health Technol Inform 2006; 124: 265-270.
  • 29 Elhadad N, McKeown K, Kaufman D, Jordan D. Facilitating physicians’ access to information via tailored text summarization. AMIA Annu Symp Proc 2005: 226-230.
  • 30 Afantenos S, Karkaletsis V, Stamatopoulos P. Summarization from medical documents: a survey. Artif Intell Med 2005; 33: 157-177.
  • 31 Reichert D, Kaufman D, Bloxham B, Chase H, Elhadad N. Cognitive analysis of the summarization of longitudinal patient records. AMIA Annu Symp Proc 2010; 2010: 667-671.
  • 32 Feblowitz JC, Wright A, Singh H, Samal L, Sittig DF. Summarization of clinical information: a conceptual model. J Biomed Inform 2011; 44 (04) 688-699.
  • 33 McMullen CK, Ash JS, Sittig DF, Bunce A, Guappone K, Dykstra R, Carpenter J, Richardson J, Wright A. Rapid assessment of clinical information aystems in the healthcare setting. An efficient method for time-pressed evaluation. Methods of Information in Medicine 2011; 50: 299-307.
  • 34 Institute of Medicine. Health IT and Patient Safety: Building safer systems for better care. Washington, DC: The National Academies Press, 2012. Available at: http://iom.edu/Reports/2011/Health-IT-and-Patient-Safety-Building-Safer-Systems-for-Better-Care.aspx (Accessed December 16, 2011).
  • 35 Singh H, Thomas EJ, Sittig DF, Wilson L, Espadas D, Khan MM, Petersen LA. Notification of abnormal lab test results in an electronic medical record: do any safety concerns remain?. The American Journal of Medicine 2010; 123 (03) 238-244.
  • 36 Ash JS, Sittig DF, Campbell EM, Guappone KP, Dykstra RH. Some unintended consequences of clinical decision support systems. AMIA Annu Symp Proc 2007: 26-30.
  • 37 Schattner A. Angst-driven medicine?. QJM 2009; 102: 75-78.
  • 38 Gandhi TK, Sittig DF, Franklin M, Sussman AJ, Fairchild DG, Bates DW. Communication breakdown in the outpatient referral process. J Gen Intern Med 2000; 15: 6.
  • 39 Thomas P, Powsner S. Data presentation for quality improvement. AMIA Annu Symp Proc. 2005: 1134.