As the move towards shared digital health records gathers pace, the dangers of mismatched records multiplies
GPs are finding it practically impossible to update their prescribing records for aged-care patients to match the medication charts kept by aged-care homes, an Australian study has found.
The findings suggest elderly patients will increasingly be put at risk as GP records go digital and are shared with other health practitioners, according to study author, Associate Professor Meredith Makeham of Macquarie University in Sydney.
“As a practising GP who visits nursing home residents and who trained in a hospital, I’ve always been aware there is difficulty in maintaining the records between our general practice and what residents are actually taking on their medication charts,” she told The Medical Republic.
“The reality of the pressures of general practice workflow is that often, when we get back to our practices, we may not have enough time to update those patients’ records on that day, or correctly, or, being human, we might forget to do it.”
In the study, researchers reviewed the records of more than 200 residents in the northern Sydney region at the same point in time, comparing notes on more than 5000 medication orders between GP records and aged care facility medication charts.
They found not one of the GPs caring for these residents had managed to keep their practice records up to date with the medication charts at aged-care facilities. The one who came closest, matching up half his records, was a very diligent doctor working part-time, and attending an aged-care home that offered cloud-based access to practice records so that he could update on his laptop, Professor Makeham said.
“The majority of people clearly didn’t have the time or resources to go to those lengths. So clearly, it’s not that we’re talking about bad doctors. We’re talking about a poorly designed digital health system that is failing the residential aged-care facility residents.”
Reporting the preliminary results at last month’s Health Informatics conference in Melbourne, she stressed the dangers of digital records containing inaccurate information.
“Perhaps we should be talking about what steps we need to take to minimise the risks these people are exposed to, perhaps by minimising the sharing of that incorrect information from GP systems, be it through the My Health Record or wherever it’s going,” she told delegates.
Residents’ paper-based records at aged-care facilities have usually been regarded as the “source of truth” when they were admitted to hospital or taken to an emergency department.
“But now as we are moving into an era of increasing digital heath innovation, we have to stop and reflect on the implications of information being taken from general practices systems rather than directly from sources such as nursing-home medication charts.”
The purpose of the study, believed to be the first to quantify this issue in Australia, was to measure the scope of the medication record-keeping problem and determine whether it posed a threat to patient safety.
Although many residential homes used sophisticated e-health software to manage care plans and workflow, they lacked functions for doctors to prescribe electronically and check for drug interactions, opening up the possibility of errors.
“If a patient at the practice is put on an antibiotic or blood pressure tablet, my computer checks that medicine against everything else they are on. In the nursing home, I have to write on a paper chart, without the clinical-decision support I am used to,” Professor Makeham said.
A GP might check for interactions back at the practice, but in all probability they would be viewing a record containing misinformation, having omitted to update data on the patient’s allergies and medications in the past.
In the absence of a solution such as cloud-based system that allowed aged-care providers and GPs to upload information, Professor Makeham said inaccuracies could multiply if GP records – once intended for the practitioner alone – were used to generate data elsewhere.
“You can imagine a situation where a third party might view a shared health summary or a referral and mistakenly think, because it has come from the patient’s GP, it must be correct,” she said.