Emergency Physician Use of the Alberta Netcare Portal, a Province-Wide Interoperable Electronic Health Record: Multi-Method Observational Study

AB-TG-Electronic Health Record Use

Alberta (ED)

Background: The adoption and   use of an electronic health record (EHR) can facilitate real-time access to   key health information and support improved outcomes. Many Canadian provinces   use interoperable EHRs (iEHRs) to facilitate health information exchange, but   the clinical use and utility of iEHRs has not been well described. 

Objective: The aim of this study was   to describe the use of a provincial iEHR known as the Alberta Netcare Portal   (ANP) in 4 urban Alberta emergency departments. The secondary objectives were   to characterize the time spent using the respective electronic tools and   identify the aspects that were perceived as most useful by emergency   department physicians. 

Methods: In this study, we have included 4 emergency departments, 2   using paper-based ordering (University of Alberta Hospital [UAH] and Grey   Nuns Community Hospital [GNCH]) and 2 using a commercial vendor clinical   information system (Peter Lougheed Centre [PLC] and Foothills Medical Centre   [FMC]). Structured clinical observations of ANP use and system audit logs   analysis were compared at the 4 sites from October 2014 to March 2016. 

Results: Observers followed 142   physicians for a total of 566 hours over 376 occasions. The median percentage   of observed time spent using ANP was 8.5% at UAH (interquartile range, IQR,   3.7%-13.3%), 4.4% at GNCH (IQR 2.4%-4.4%), 4.6% at FMC (IQR 2.4%-7.6%), and   5.1% at PLC (IQR 3.0%-7.7%). By combining administrative and access audit   data, the median number of ANP screens (ie, results and reports displayed on   a screen) accessed per patient visit were 20 at UAH (IQR 6-67), 9 at GNCH   (IQR 4-29), 7 at FMC (IQR 2-18), and 5 at PLC (IQR 2-14). When compared with   the structured clinical observations, the statistical analysis of screen   access data showed that ANP was used more at UAH than the other sites. 

Conclusions: This study shows that   the iEHR is well utilized at the 4 sites studied, and the usage patterns   implied clinical value. Use of the ANP was highest in a paper-based academic   center and lower in the centers using a commercial emergency department   clinical information system. More study about the clinical impacts of using   iEHRs in the Canadian context including longer term impacts on quality of   practice and safety are required.

Authors: Timothy AD Graham, Maark Ballerrmann, Eddy Lang, Michael J Bullaard, Denise Paarsons, Gabriella Mercuur, Pat San Agustin, Samina Ali

Timothy AD Graham - tim.graham@ahs.ca

Preliminary data gathering / Baseline