Clinicians Perform “Chart Biopsies” to Prepare for Patient Handoffs

A new AHRQ-funded study examines the practice of chart biopsies, a process that allows clinicians to understand the services that patients have received before they are transferred to another care setting. The term “chart biopsy” refers to the activity of examining portions of a patient’s electronic health record (EHR) to gather specific information about that patient or to develop a broader understanding of the patient’s care, according to the study. With many hospitals moving to EHRs, practitioners can now view patient records before patients are transferred. Chart biopsies enable receiving clinicians to gain a stronger understanding of the patient’s condition, allow receiving practitioners to better prepare for handoff and subsequent care, and guard against possible bias in verbal reports. Proponents point out that chart biopsy provides a tool to enrich coordination and collaboration, which may enable safety, efficiency and effectiveness of medical care. The study, “Chart Biopsy: An Emerging Medical Practice Enabled By Electronic Health Records and Its Impacts on Emergency Department-inpatient Admission Handoffs,” was published in the September 2012 issue of the Journal of the American Medical Informatics Association. Select to access the abstract on PubMed.®

J Am Med Inform Assoc. 2012 Sep 12. [Epub ahead of print]

Chart biopsy: an emerging medical practice enabled by electronic health records and its impacts on emergency department-inpatient admission handoffs.

Hilligoss B, Zheng K.

Source

College of Public Health, Division of Health Services Management and Policy, Ohio State University, Columbus, Ohio, USA.

Abstract

OBJECTIVE:

To examine how clinicians on the receiving end of admission handoffs use electronic health records (EHRs) in preparation for those handoffs and to identify the kinds of impacts such usage may have.

MATERIALS AND METHODS:

This analysis is part of a two-year ethnographic study of emergency department (ED) to internal medicine admission handoffs at a tertiary teaching and referral hospital. Qualitative data were gathered and analyzed iteratively, following a grounded theory methodology. Data collection methods included semi-structured interviews (N = 48), observations (349 hours), and recording of handoff conversations (N = 48). Data analyses involved coding, memo writing, and member checking.

RESULTS:

The use of EHRs has enabled an emerging practice that we refer to as pre-handoff "chart biopsy": the activity of selectively examining portions of a patient's health record to gather specific data or information about that patient or to get a broader sense of the patient and the care that patient has received. Three functions of chart biopsy are identified: getting an overview of the patient; preparing for handoff and subsequent care; and defending against potential biases. Chart biopsies appear to impact important clinical and organizational processes. Among these are the nature and quality of handoff interactions, and the quality of care, including the appropriateness of dispositioning of patients.

CONCLUSIONS:

Chart biopsy has the potential to enrich collaboration and to enable the hospital to act safely, efficiently, and effectively. Implications for handoff research and for the design and evaluation of EHRs are also discussed.