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01.12.2012 | Research article | Ausgabe 1/2012 Open Access

BMC Health Services Research 1/2012

Integrating a health-related-quality-of-life module within electronic health records: a comparative case study assessing value added

BMC Health Services Research > Ausgabe 1/2012
Christopher M Shea, Jacqueline R Halladay, David Reed, Timothy P Daaleman
Wichtige Hinweise

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

CS participated in designing the study, led analysis of qualitative interview data, and drafted the manuscript. JH participated in designing the study, debriefed the research assistant to capture observational data, validated themes identified in the qualitative analysis, and assisted with editing the manuscript. DR provided analysis of quantitative data and assisted with editing the manuscript. TD participated in designing the study, validated themes identified in the qualitative analysis, and assisted with editing the manuscript. All authors read and approved the final manuscript.



Health information technology (HIT) applications that incorporate point-of-care use of health-related quality of life (HRQL) assessments are believed to promote patient-centered interactions between seriously ill patients and physicians. However, it is unclear how willing primary care providers are to use such HRQL HIT applications. The specific aim of this study was to explore factors that providers consider when assessing the value added of an HRQL application for their geriatric patients.


Three case studies were developed using the following data sources: baseline surveys with providers and staff, observations of staff and patients, audio recordings of patient-provider interactions, and semi-structured interviews with providers and staff.


The primary factors providers considered when assessing value added were whether the HRQL information from the module was (1) duplicative of information gathered via other means during the encounter; (2) specific enough to be useful and/or acted upon, and; (3) useful for enough patients to warrant time spent reviewing it for all geriatric patients. Secondary considerations included level of integration of the HRQL and EHR, impact on nursing workflow, and patient reluctance to provide HRQL information.


Health-related quality of life modules within electronic health record systems offer the potential benefit of improving patient centeredness and quality of care. However, the modules must provide benefits that are substantial and prominent in order for physicians to decide that they are worthwhile and sustainable. Implications of this study for future research include the identification of perceived "costs" as well as a foundation for operationalizing the concept of "usefulness" in the context of such modules. Finally, developers of these modules may need to make their products customizable for practices to account for variation in EHR capabilities and practice workflows.
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