Background
A shared electronic health record (SEHR) system is distinguished by its availability to multiple healthcare providers, typically working from different institutions across health services. SEHRs are intended to facilitate clinician access to past medical history (PMH) to improve patient care and/or reduce the cost of care.1 A primary reason for building an SEHR system is to ensure that important patient information is available for unscheduled care such as medical emergencies.2 3
Our previous review of SEHR use during unscheduled care found that while many SEHRs were large in scale and serviced many millions of patients, reported record utilisation rates by clinicians were variable but low.4 Higher record access rates were found in USA and Israeli healthcare maintenance organisations (16%–30%). Lower rates were reported for nation-scale systems (1.5%–2%) or when data exchange occurred between disparate provider systems. Our subsequent study of SEHR access in a hospital emergency department (ED) demonstrated that records were routinely used and usage was growing over time.5 Usage patterns revealed the highest rates for specific groups such as older or sicker patients.
It seems therefore that there are use cases where SEHR access is of higher value, and as a corollary, there should be SEHR designs that are more acceptable because they optimise support for those use cases. To clarify high-value SEHR use cases and designs, we undertook a survey of ED and urgent care (UC) clinicians across Australia and New Zealand. The study compared clinicians’ experiences using an SEHR to access PMH to those of clinicians with no current access, and explored technology adoption levers and specific design attributes that may make SEHR access most useful. We also explored related questions, including the value of accessing PMH during the COVID-19 (SARS-CoV-2) pandemic, of accessing advance care directives (ACDs), as well as the potential risks of using PMH, and specifically, whether accessing such data introduces a framing bias that negatively influences clinician decision making.6
Typically, an individual’s perceptions of a new technology change after exposure to it. In this study, we sought to compare the expectations of ED and UC clinicians without access to their patients’ PMH to the experiences of those clinicians that did have access.