This article originally appeared in the Summer 2023 issue of the Ontario Medical Review magazine.
Increase in reports creating administrative backlog for physicians using EMRs
An influx of millions of reports each month from 500-plus sending sites through Health Report Manager has prompted OntarioMD and other health-system partners to unite and address this report management burden.
The HRM® tool has delivered electronic patient reports from hospitals and specialty clinics directly to more than 13,000 physicians’ electronic medical records for the past decade.
The HRM Experience Improvement Task Force – chaired by OntarioMD and including health-system partners such as the OMA, Ontario Health, the Ontario Hospital Association, hospitals, EMR vendors and Hospital Information System vendors – plays a key role in the electronic delivery of clinical reports from acute-care settings to community physicians.
Acknowledging physician calls for improvements, the task force is assessing report delivery issues to provide meaningful recommendations and identify solutions. Tackling these issues will help physicians spend less time on administrative tasks and documentation review, so they can focus more on patient care.
Here are the top four issues HRM users identified that contribute to administrative burden and are now under investigation by the HRM task force.
There is no policy or standard to dictate which reports, transported easily through the HRM from an HIS, are sent to community-based physicians. Physicians, therefore, often receive all types of hospital reports, including a high volume of in-patient records and other reports not clinically relevant to patient files and risk missing critical patient-care information.
Action: Community-based physicians were asked which reports are necessary to inform a core report outlining recommendations for facilities, such as hospitals and specialty clinics. These reports were assessed by the task force and final recommendations were brought to health-system stakeholders, such as the College of Physicians and Surgeons, for their support.
Some hospitals still fax reports, in addition to sending them through HRM, duplicating the reports physicians receive. Doctors may also receive multiple electronic copies of the same report in draft and final form due to minor adjustments or delayed sign off. These upstream actions by hospitals also bog down inboxes and could compromise access to critical patient information.
Action: The task force is developing recommendations to address duplicate reports by reviewing HRM data, such as the number of reports delivered. Recommendations are expected by the end of the summer and will be reviewed by other stakeholders, including Ontario Health.
There are no guidelines for hospitals to follow to standardize report labelling in their HIS. Inconsistent report-naming across hospitals and other sending facilities makes it difficult for recipients, such as community-based physicians, to find relevant information quickly.
Action: The task force is finalizing its recommendations for consistent report-labelling using standardized naming conventions. For example, a provincial subset of Logical Observation Identifiers Names and Codes could be implemented across hospital sites. Recommendations will be shared and implemented once approved by OMD’s health-system partners.
There are no provincial standards addressing how content appears or is structured in reports, whether sent electronically or by fax. For example, reports delivered from hospitals using HRM are often several pages long with inconsistent formatting. Document length makes it challenging for physicians to quickly locate relevant patient information.
Action: The task force is examining how hospitals can ensure physicians find the most clinically relevant information in reports quickly through better formatting.
The HRM Task Force is finalizing its work and will publish a report in the fall. Reports will be available on the Task Force page of OMD’s website with updates provided in the Digital Health eTips newsletter. Sign up to receive eTips at OntarioMD.ca.