Algorithm uses EHR to distinguish care from nurses, physicians

Researchers at the University of Illinois at Chicago have developed an algorithm capable of extracting data from patient electronic health records (EHRs) to show the difference in care provided by physicians and nurses. Findings were published online Feb. 9 in the International Journal of Medical Informatics.

Physicians and nurses have a collabrative relationship when it comes to patient care and provide specific care based on their role. In this study, researchers used computer technology to compare patient care provided by nurses and physicians using EHR data.  

"We've created a more unified picture of health care professionals' perspectives on their patients," said corresponding author Andrew Boyd, assistant professor of biomedical and health information sciences in the UIC College of Applied Health Sciences. "Previous studies on this topic have been limited by their reliance on qualitative, observation-based data collection or costly survey methods—ours is the first to objectively measure the scope of practice when nurses and doctors care for the same patients."

The study included EHR data from 58 patients diagnosed with heart failure who sought care at a single academic medical center over the course of eight years. Researchers built the algorithm to identify key biomedical terms used in physician and nurse summaries to display a graph of the integrated relationship of language and health terminology.  

"Because providers are changing, the dynamics of collaboration are also changing—this underscores the importance of the electronic health record as perhaps the single most important communication tool used to coordinate care across disciplines in hospitals today," Boyd said. "As the algorithm used in the study can be universally applied to any health record, it has incredible potential for identifying gaps in care and even improving quality and quality reporting."

Results showed only 26 percent of EHRs had an overlap of terms, with an average of four terms being shared between nurses and physicians when related to the same topic. Physicians used an average of 27 terms compared to nurses using 18 terms. Physicians tended to focus on highly technical terms while nurses focused on symptoms and responses to illness.

"Patients who are hospitalized need hands-on nursing care in addition to the treatments ordered by a physician," said co-author Karen Dunn Lopez, assistant professor in the UIC College of Nursing. "This is the first evidence of its kind that illustrates how the scope of nursing practice runs parallel to, but independent of, 'doctor's orders.'”