A Study to the Impact of Accuracy Problem Lists in Electronic Health Records on Correctness and Speed of Clinical Decision-making Performed by Dutch Healthcare Providers

Summary

The primary objective of this study is to determine whether patient records with complete, structured and up-to-date problem lists ('accurate problem lists'), result in better clinical decision-making, compared to patient records that convey the same information in a less structured way where the problem list has missing and/or duplicate diagnoses ('inaccurate problem lists'). The secondary objective is to determine whether the time required to make a correct decision is less for patient records with accurate problem lists compared to patient records with inaccurate problem lists.

Conditions

• Clinical Decision-Making
• Decision Making, Computer-assisted
• Medical Records, Problem-Oriented
• Quality of Health Care
• Evidence-Based Practice
• Data Accuracy
• Documentation / Standards
• Documentation / Statistics & Numerical Data
• Forms and Records Control / Standards
• Humans
• International Classification of Diseases / Standards

Interventions

OTHER

patient A with accurate problem list

A problem list that contains a diagnosis code that is contraindicated with a type of medication (Y). Also, all other relevant diagnoses and medical history for the patient are up-to-date on the problem list, which was defined according to the problem list policy at our institution (i.e. all current active problems and relevant medical history should be documented on the problem list). Additionally, the problem list is included in eight out of thirteen notes using so-called smart phrases that can automatically import a (part of a) problem list. One note includes the problem list with the diagnosis relevant for the question asked.

OTHER

patient B with inaccurate problem list

A problem list that does not contain the diagnosis code and corresponding details explaining medical history of this diagnosis caused by a type of medication (Y). Additionally, the problem list is included in three out of thirteen notes using so-called smart phrases that can automatically import a (part of a) problem list. The relevant diagnosis is not documented on the problem list and hence is not included in the imported problem list in the notes. The expert panel provided and anonymized two real-world representative examples of hematology patient records that included inaccurate problem lists and that had many free-text notes. An 'inaccurate problem list' is defined as a problem list where diagnoses are missing resulting in missed trigger medication or order-alerts, where diagnoses are 'active' although they should be closed or removed and/or where the problem list contained duplicated diagnoses.

OTHER

patient A with inaccurate problem list

A problem list that does not contain the diagnosis code that is contraindicated with the type of medication (Y). Additionally, the problem list is included in eight out of thirteen notes using so-called smart phrases that can automatically import a (part of a) problem list. The relevant diagnosis is not documented on the problem list and hence is not included in the imported problem list in the notes. The expert panel provided and anonymized two real-world representative examples of hematology patient records that included inaccurate problem lists and that had many free-text notes. An 'inaccurate problem list' is defined as a problem list where diagnoses are missing resulting in missed trigger medication or order-alerts, where diagnoses are 'active' although they should be closed or removed and/or where the problem list contained duplicated diagnoses.

OTHER

patient B with accurate problem list

A problem list that contains the diagnosis code and corresponding details explaining medical history of this diagnosis caused by a type of medication (Y). Also, all other relevant diagnoses and medical history for the patient are up-to-date on the problem list, which was defined according to the problem list policy at our institution (i.e. all current active problems and relevant medical history should be documented on the problem list). Additionally, the problem list is included in three out of thirteen notes using so-called smart phrases that can automatically import a (part of a) problem list. One note includes the problem list with the diagnosis and details relevant for the question asked.

Sponsors & Collaborators

• Eva Klappe

  lead OTHER

Principal Investigators

• Eva Klappe, MSc · Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)

Study Design

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

SINGLE

Model

CROSSOVER

Eligibility

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2022-12-01

Primary Completion

2022-12-21

Completion

2022-12-21

Countries

• Netherlands

Study Locations