gms | German Medical Science

Background and objective: Geriatric patients are often treated by a large number of healthcare providers with different tasks and competences, which entails an increased need for communication and exchange of data. Regional Electronic Health Records (EHR), jointly managed by all providers involved in the treatment, have high potential to support regional healthcare of elderly patients. The aim of this study was to develop a Regional Digital Health Record (ReDiFa) together with geriatric healthcare providers in regions of Mecklenburg-Western Pomerania.

Research questions: Which functions should be included in an EHR for geriatric care? Which barriers and facilitators are expected towards the implementation of an EHR?

Methods: ReDiFa was developed according to the Community-Based Participatory Research approach (CBPR). CBPR is a mixed methods approach involving all stakeholders. The following stages were completed: identification of suitable regions, identification of regional stakeholders, identifying local needs, development of a content concept, programming and testing of ReDiFa. Data were collected by participant observation, informal interviews and a standardized questionnaire. Content analysis were used for qualitative findings and statistical analysis for quantitative ones.

Results: 3 focus regions were identified, 22 geriatric healthcare providers participated in the development of ReDiFa and 4 workshops were conducted to discuss functionalities needed. Main outcomes were, that ReDiFa should support the exchange of assessments, diagnoses, medication, assistive device supply and social information. Specific applications are wound care (information sharing between GP and nursing service), discharge management from the hospital to primary care, and transfer management from acute-inpatient to rehabilitation treatment. 12 participants responded to a questionnaire: nursing services, hospitals, GPs, and therapists are the most important communication partners in geriatric care. The participants often need information from other healthcare providers about prescribed assistive devices, therapies, medication, vaccination and the patients. The ReDiFa is considered to be able to improve the quality and continuity of care. Main barriers for using an EHR are: lack of resources, interoperability issues, computer illiteracy, lack of trust, privacy concerns, and ease-of-use issues. Based on the results of the workshops, observations and the questionnaire, ReDiFa was programmed and tested by the stakeholders.

Discussion: EHRs are necessary to improve continuity and quality of geriatric healthcare. Using an EHR improves especially the discharge process after an inpatient stay and the coordination of different outpatient treatment modalities. An EHR system should be adaptable to regional needs. Existing interdisciplinary and cross-sectoral care concepts seem to facilitate the use of an EHR system. Healthcare providers are interested in supporting the development of an EHR, but they often lack the required time, knowledge and resources.

Practical implications: Users should be involved in all stages of the development in order to design a useful EHR and to increase the uptake of EHR systems.