Can you hear me now?
Hearing loss not well documented in electronic medical records
From Massachusetts Eye and Ear Infirmary 3/23/09
Findings: A study looking at the electronic medical records of 100 consecutive people who came to the Massachusetts Eye and Ear Infirmary for hearing tests that revealed substantial hearing loss in both ears found that only 28 percent of these people were noted by their primary care doctors to have hearing loss and 36 percent were noted to have normal hearing. This study suggests that hearing loss is under-recognized and/or underreported by general medical doctors.
Relevance: With more physician practices and hospitals switching to electronic medical records, there is an opportunity to better utilize this technology to document hearing loss and accommodate patients’ communication needs.
Hearing loss is a common disorder that can cause significant communication difficulties and directly affect the accurate transfer of information during a medical encounter. Hearing loss also often increases with age; as the Baby Boomers get older, the prevalence of hearing loss will increase.
Documentation of hearing loss in the electronic medical record (EMR) can remind physicians that it is necessary to accommodate patients’ communication needs and thus improve the quality of interpersonal interaction and information transmission between patients and physicians. Widespread use of EMR at the Massachusetts Eye and Ear Infirmary and Massachusetts General Hospital offered researchers the opportunity to document known substantial binaural (in both ears) hearing loss in notes summarizing comprehensive medical histories and physical examinations. Their findings are outlined in the April 2009 issue of the Journal of General Internal Medicine and were published earlier on line. http://www.springerlink.com/content/l7756224175662l1/
Researchers retrospectively screened the charts of all patients (approximately 1,200) who underwent audiometry (hearing testing) in the audiology department at Mass. Eye and Ear from July 18, 2007 to August 10, 2007. Patients were qualified to be part of the study if they had a disabling hearing loss in both ears that was very likely to have existed two years before the hearing testing. Patients with mild to moderate conductive hearing loss were excluded, including those whose hearing loss was caused by impacted ear wax. Of all the charts for patients who received hearing testing in that timeframe, 680 were adults who had searchable EMRs, and of those 254 met their hearing criterion. The research sample consisted of the first 100 patients of the 254 who had recent, sufficient and comprehensive EMR notes to review for documentation of hearing loss.
The results of the reviews of histories and physicals showed that out of 100 patient EMRs, only 28 records contained any mention of hearing loss, and just one patient had “hearing loss” on her EMR problem list. Of those cases with hearing loss noted, eight referrals were made for this condition. Hearing loss was not mentioned in 36 records. The final 36 records noted that the patient had normal hearing mostly by using the stock phrase, “CNI-XII WNL,” which means that the cranial nerve VIII (acoustic) was within normal limits. In a separate analysis of the group with hearing loss versus the group reported as normal, patients with hearing aids were significantly more likely to be documented and less likely to be reported normal than those without hearing aids.
This is the first study of its kind to document that patients with hearing loss significant enough to impede adequate communication in a medical encounter do not have this fact regularly documented in their EMRs and that physicians may not even recognize this disability in their patients. More research is needed to determine whether the lack of documentation of significant hearing loss in EMRs actually reflects a lack of recognition of the problem.
“These findings are best viewed as an opportunity for both patients and physicians to better report, document and accommodate for hearing loss,” said Chris. Halpin, Ph.D., of Mass. Eye and Ear Audiology and lead author. “Once hearing loss is documented, an electronic alert system in the EMR could remind the physician to use communication strategies such as adding time and precision to speech and being sure to face the patient when speaking. Such alerts are already in place to remind physicians about due dates for various screenings and preventative services.”
Founded in 1824, the Massachusetts Eye and Ear Infirmary is an independent specialty hospital, an international center for treatment and research, and a teaching affiliate of the Harvard Medical School. Information about the Massachusetts Eye and Ear Infirmary is available on its website at www.MassEyeAndEar.org.
– Thanks to Bob MacPherson and NVRC, Fairfax