Enabling patient tracking for physicians out of the feedback loop
May 5, 2022
By Constanza Villalba, PhD
Emergency medicine physicians want to know the outcomes of their care; we’re collaborating with Beth Israel Deaconess Medical Center to understand their pain points.
Imagine a job in which you made critical — even life-and-death — decisions for people on a daily basis but seldom knew for sure whether those decisions were the right ones. Worse, imagine that the few times you did find out about the repercussions of your decisions, it was only to learn that something had gone wrong.
Well, welcome to the life the emergency medicine physician.
When patients come into the emergency department, the physicians treating them must assess their condition, stabilize and treat them, and determine whether they need to be admitted to the hospital or can go home. When an emergency physician’s shift ends, any patients that are in process get transitioned to the physician coming on shift. The pace is brisk and the stakes are high; emergency physicians must make decisions quickly, sometimes before all the relevant information is available. Once a patient does get admitted or sent home, that’s usually the last the emergency physician knows of that patient.
This lack of a feedback loop is vexing to emergency physicians. Without it, they do not get the chance to calibrate their performance based on their patients’ denouement. They might ask themselves, “That patient I admitted with chest pain — was she having a heart attack or something else?” Or, “The antibiotics I administered to the patient I sent home — did they clear the infection, or is the patient still symptomatic?”.
Recognizing the importance of the feedback loop in emergency medicine, our innovation team at Elsevier Clinical Solutions set out to understand how emergency physicians grapple with this problem. It turns out that the motivation to learn from past cases is so strong that emergency physicians often look up former patients in the electronic health record (EHR) to find out how the patients fared. This process, which we termed “patient tracking,” may seem like an easy, effective solution, but the reality is much more complicated.
That’s why, when we learned that Beth Israel Deaconess Medical Center (BIDMC)(opens in new tab/window) in Boston had built an electronic patient tracking tool for their emergency physicians, we established a research collaboration with them to study patient tracking among emergency physicians. In February we published our findings in Academic Emergency Medicine Education and Training(opens in new tab/window).
For the study, we surveyed the emergency physicians practicing at four BIDMC hospitals and two nearby affiliated hospitals about their patient tracking behaviors. Almost all the respondents (98%) reported tracking their patients and strongly agreed or agreed that tracking helps physicians avoid future mistakes. Indeed, most respondents (86%) said that knowledge gained from patient tracking changed how they handled future patients.
Here’s why the findings are notable: Although our study suggests that patient tracking is nearly ubiquitous (at least among the physicians we studied), many hospitals in the United States prohibit physicians from looking at the record of patients for whom they are no longer responsible. What’s more, legal scholars are divided on whether tracking former patients is sanctioned by HIPAA(opens in new tab/window), the US law that protects patient privacy.
Why is it even a question?
According to some, physicians should not access records for patients whose care they can no longer influence. On the other hand, clinical quality experts, including the authors of the 2015 National Academy of Medicine report on diagnostic error(opens in new tab/window), cite the lack of a feedback loop in medicine as a key driver of medical error.
In our own study, the most common reasons for tracking included an unusual or complex case (98%) and an uncertain diagnosis (89%), but roughly half the respondents reported tracking when they were concerned about a potential error (48%). These data underscore the importance patient tracking has to clinical calibration, and yet respondents told us they lack sufficient time to do the tracking they would like to do and that the information they need is difficult or impossible to find within the EHR.
This issue speaks to a larger trend in medicine, highlighted Elsevier’s Clinician of the Future report: the ever-growing need physicians have to be digital and data literate.
Through research like this, Elsevier hopes to better understand the technological needs of clinicians so that we can better support them in their work. Dr Shamai Grossman(opens in new tab/window), Vice-Chair of Healthcare Quality in the Department of Emergency Medicine at BIDMC and Associate Professor of Emergency Medicine at Harvard Medical School(opens in new tab/window), who was the principal investigator on the tracking study, notes that, “It’s interesting to see Elsevier expanding its role in healthcare and reaching further into the health information technology realm.”
Clinician of the Future: Report 2022, Constanza Villalba, Ryan C Burke, Kiersten Gurley, Gurpreet Dhaliwal, Shamai Grossman (Elsevier, 2022)
Electronic health record-based patient tracking by emergency medicine physicians(opens in new tab/window), AEM Education and Training (Wiley, 2022)