Electronic medical records involve some negatives

May 3, 2010

Most Americans will likely have their health information turned into electronic medical records over the next decade. A large chunk of federal stimulus money is being used for this effort aimed at improving patient care and reducing medical errors. However, a new study from the W. P. Carey School of Business at Arizona State University shows there are some real negatives that come with the positives of electronic medical records.

“Everyone has been saying that health IT will save money, but our study and others cast doubt on some of the savings,” explains Assistant Professor Michael Furukawa, one of the study’s authors. “The bottom line is that electronic medical records do appear to help lower mortality rates at hospitals, but they don’t necessarily help reduce the number of patient medical complications or reduce costs, especially in the area of nursing.” Download Full Image

Furukawa and his colleagues, Associate Professors Raghu Santanam and Benjamin Shao, analyzed data from more than 300 California hospitals that adopted some form of electronic medical records over a decade from 1998 to 2007. Their research was just published by the journal Health Services Research. Contrary to expectations, they found electronic medical records implementation was actually linked to higher hospital costs, and in some cases, lower quality of care.

“There’s a disconnect in the policy world that assumed that with all of the records moved into the computer system, nurses and other hospital personnel could spend less time running around looking for charts and that they would have more time to spend with patients,” says Santanam. “While some documentation time was reduced, a lot of time at computers may have been added, especially at organizations just learning to implement the new technology in a likely transition period. Higher levels of nurse staffing were really needed.”

The study did find that hospitals saw better results from the use of electronic medical records as their implementation and techniques got more advanced, so cost savings may improve at hospitals over time. Also, less money was spent specifically on overtime for nurses, presumably because personnel began to enter data into the computers as their shifts progressed, instead of waiting until the end of the shift to write everything onto paper charts.

However, patient hospital stays got longer in many cases, possibly because using the computer systems took nurses away from their work caring for patients. Also, more highly educated nurses were required to efficiently use the new systems.

“This could have real implications for the labor market nationwide,” says Shao. “Some areas already have registered nurse shortages, and that problem could be exacerbated with the implementation of electronic medical records.”

On the positive side, hospitals experienced lower death rates for certain conditions. The electronic medical records also contributed to fewer medication errors and may have resulted in less ordering of unnecessary, duplicate tests.

“We’re not saying electronic medical records aren’t the way to go in the future for the purposes of information-sharing and reducing medical errors,” says Furukawa. “However, health practitioners, hospital managers and policy makers should temper their expectations of short-term savings from health IT. This is just a reality check that implementing these systems may be more challenging than expected.”

“Most hospitals still aren’t rethinking how they do things; they’ve just been integrating the electronic medical records into their current processes,” explains Santanam. “They may need to completely reexamine their processes to maximize the new technology. Maybe they just haven’t realized the full potential.”

The new study was partly sponsored by the Center for Health Management Research, a program of the Health Research and Educational Trust. The results of the study called “Electronic Medical Records, Nurse Staffing, and Nurse-Sensitive Patient Outcomes: Evidence from California Hospitals, 1998-2007” can be found at http://www3.interscience.wiley.com/cgi-bin/fulltext/123346351/PDFSTART.">http://www3.interscience.wiley.com/cgi-bin/fulltext/123346351/PDFSTART">...

Research focuses on mother-daughter communication

May 3, 2010

The statistics are alarming. Breast cancer incidence in women in the United States has increased from 1 in 20 in 1960 to 1 in 8 today. For women in the United States., breast cancer death rates are higher than those for any other cancer besides lung cancer. About 40,170 American women were expected to die from breast cancer in 2009. As of 2008, there were about 2.5 million women in the United States who have survived breast cancer. And a woman’s risk of breast cancer nearly doubles if she has a first-degree relative who has been diagnosed with the disease.

According to http://www.breastcancer.org" target="_blank">breastcancer.org, the numbers are starting to come down, though only slightly, as treatments improve and awareness increases. Image of (from left to right) Carla Fisher, Teri Pipe, Katherine Hunt Download Full Image

Carla L. Fisher, an assistant professor in the Division of Social and Behavioral Sciences in Arizona State University’s">http://newcollege.asu.edu/"> New College of Interdisciplinary Arts and Sciences, is launching a research project through the ASU-Mayo Clinic Partnership for Collaborative Research (PARCORE) designed to strengthen the communication and coping patterns of mothers facing breast cancer and their young-adult daughters. Fisher will be working in collaboration with Teri Britt Pipe, director of nursing research and innovation and an associate professor of nursing at the Mayo Clinic College of Medicine in Phoenix, and Katherine S. Hunt, an assistant professor in the Division of Hematology/Oncology.

The new study is an extension of research Fisher conducted while working on her doctoral dissertation at Pennsylvania State University that looked at how women diagnosed in young, middle and later adulthood adapt to breast cancer through their mother-daughter communication.

“It seems everyone knows someone with breast cancer,” said Fisher, who earned her master’s in communication studies at ASU’s West campus in 2004 before receiving her doctorate from Penn State in 2008.  “The medical community is recognizing more and more that cancer is not experienced by the patient alone, but within her family. The whole family is affected by the diseases and its associated challenges. As such, the family copes together.”

Fisher has long been interested in mother-daughter communication. She was awarded her bachelor’s degree in scientific and technical communication from the Florida Institute of Technology after once considering environmental science courses at the Melbourne-based university. Her writing skills led her on the path to communication studies and her graduate thesis centered on mother-daughter communication. She joined the New College faculty at ASU in 2008 and in addition to her teaching responsibilities on the West campus, is also a member of the graduate faculty in the Hugh">http://humancommunication.clas.asu.edu/">Hugh Downs School of Human Communication in the http://clas.asu.edu" target="_blank">College of Liberal Arts and Sciences on the Tempe campus. Her research interests focus on intergenerational family communication and its connection to wellness.

Fisher said that in her many studies of such communication, breast cancer became a recurring subject. Although the issue was an important one, she didn’t find much research available. In her new research, Fisher and her collaborators will be looking specifically at young-adult daughters and their diagnosed mothers and examining how their interaction affects their ability to cope.

“For women diagnosed with breast cancer, mother-daughter pairs are particularly affected for a whole host of reasons,”  Fisher said. “I found in my previous research that mothers and daughters have unique experiences that are important to explore more so. In addition to looking at their interaction, we’ll also study how they talk about health promotion behaviors such as getting mammograms or deciding to get genetic testing.”

Fisher is the coordinator of research for ASU’s Family">http://famcom.asu.edu/">Family Communication Consortium, an interdisciplinary collaboration promoting healthy family communication through research, teaching and service activities of ASU faculty and students.  She said that family communication is tied to our own health and well-being across our lifespan and is just as important to our survival as physical or biological processes.

“Our family interactions really affect how we adjust to challenging circumstances and can be instrumental in our ability to emerge resilient," Fisher said. "When coping with cancer, we know that patients who perceive they have good support interactions within their family network also have better psychological, social and physiological well-being in comparison to those who don’t.

“However, we don’t always communicate in healthy ways, since we are not born with competent communication skills and, not surprisingly then, families sometimes communicate in ways that don’t maximize their own well-being.

“By talking with mothers and daughters coping with breast cancer we can better understand their experiences, their needs, and ultimately how to communicate in healthy ways – ways that enhance both patients’ and families’ wellness.”

For Mayo’s Pipe, the collaboration has bright prospects.

“This particular project with Fisher has the potential for fairly immediate benefit,” Pipe said.  “We hope to strengthen the communication and coping patterns of mothers facing breast cancer and their young-adult daughters.  When these patterns are strengthened, there are benefits to the relationship and each of the participants; mother and daughter. 

Also, it opens the dialogue for the daughter about health promotion behaviors that may be particularly salient for her, given a family history of breast cancer.”

Fisher believes the research could lead to a more holistic approach to breast cancer care and treatment.

“Ultimately, the hope is that mothers’ and daughters’ stories from this research can be implemented into support services for other mothers and daughters,” she said. “The long-term hope is really to use the knowledge gained from this study to provide families with guidance in coping with cancer, providing them with psycho-social interventions as well as psycho-education on healthy coping.”

The research grant is part of a PARCORE seed grant program to encourage new research projects between ASU and Mayo Clinic collaborators. Since its first round in 2004, the program has awarded grants to five research teams annually.  Successful applications are judged to be well-conceived pilot studies that possess a high probability of leading to later proposals to the National Institutes of Health (NIH) or to other peer review and grant funding agencies for longer term project support. Highest priority is given to new projects that enhance collaborations between ASU and Mayo Clinic.

“Collaboration is important because it helps expand our expertise by building productive and mutually beneficial relationships with ASU faculty members for the ultimate goal of providing the absolute best patient care,” said Pipe, who has worked on a wide variety of collaborations with university faculty. “As these collaborations grow, so does the depth and breadth of what we can do on behalf of our patients.

“This research benefits the community by bringing together three investigators with very different academic and clinical preparations, each of us motivated by the desire to have a positive impact on women’s health outcomes. Translating research findings into clinical practice will be more likely because we have at least three academic audiences we can reach out to: communication studies, genetic counseling and nursing.”

To better understand how a mother and her daughter(s) are affected by breast cancer diagnosis, the research team would like to talk with diagnosed mothers and their young-adult (aged 18-30) to learn more about how they managed difficult discussions related to coping and adjustment, as well as disease prevention. The team is looking for women who have been diagnosed and have received treatment within the last three years who also have young-adult daughters willing to participate. 

For more information, e-mail MothersandDaughters">mailto:MothersandDaughters@asu.edu">MothersandDaughters@asu.edu or call 602-543-6669.

Steve Des Georges

director strategic marketing and communication, Enterprise Marketing Hub