Aligning the EHR with Age-Friendly Care in Hospitals: A qualitative multi-site study

The geriatric 4Ms framework conceptualizes four evidence-based elements (i.e., Mobility, Mentation, Medication, what Matters) important to high quality care for older adults. Improving on these measures is central to the Age Friendly Health Systems initiative. Electronic health records (EHR) are critical to modern health systems including being able to review patient information and act on geriatric health concerns.

The objective of this study was to examine how clinicians use a commercial EHR to access 4Ms-relevant information during inpatient and emergency care of older adults in order to inform the design of scalable, age-friendly 4Ms EHR tools.

We interviewed clinicians and clinical staff (n=20) including physicians, advanced practice providers, nurses, pharmacists, and physical therapists from five large academic health systems across the United States about their experiences using the EHR during inpatient and emergency care for older adults. All included health systems use the same EHR and have geriatric quality programs in place. Participants completed interviews virtually, and narrated walk throughs of their local EHR build in response to three brief clinical vignettes focused on falls, home care needs, and delirium. Interviews were screen recorded with audio and transcribed for coding and thematic analysis.

Major themes cut-across the 4Ms and included: (1) difficulty finding information about the 4Ms, (2) poor 4Ms data quality, (3) sparse EHR data sharing, (4) intra-facility variation in practices, and (5) homegrown 4Ms EHR tools. Interviewees shared some examples of tools that had been implemented in their practice settings that increased access to 4Ms data, including documentation search workarounds, trackboards, and alerts.

Among a sample of clinicians and clinical staff representing large academic medical centers, 4Ms data in the EHR was characterized by multi-level barriers related to access and accuracy. Alternatively, interviewees demonstrated innovative EHR-embedded tools to improve accessibility of some 4Ms relevant data. These findings inform the future development and refinement of a comprehensive geriatric 4Ms EHR tool for the ED and inpatient setting.