Feasibility of real-time capture of routine clinical data in the electronic health record: a hospital-based, observational service-evaluation study.

ABSTRACT:

Objectives

The electronic health record (EHR) is underused in the hospital setting. The aim of this service evaluation study was to respond to National Health Service (NHS) Digital's ambition for a paperless NHS by capturing routinely collected cardiac outpatient data in the EHR to populate summary patient reports and provide a resource for audit and research.

Design

A PowerForm template was developed within the Cerner EHR, for real-time entry of routine clinical data by clinicians attending a cardiac outpatient clinic. Data captured within the PowerForm automatically populated a SmartTemplate to generate a view-only report that was immediately available for the patient and for electronic transmission to the referring general practitioner (GP).

Results

During the firs

SUBMITTER: Bodagh N 

PROVIDER: S-EPMC5855191 | biostudies-literature | 2018 Mar

REPOSITORIES: biostudies-literature