Digital solutions in acute medicine: Will electronic health records join up the patient journey (soon?).

Abstract

Acute medicine provides care to patients during the first 72 h of their hospital stay. Clinicians face unique challenges of complexity in having to care simultaneously for groups of patients with multiple medical conditions and often complex needs. Digital innovation is central to modern clinical practice, yet its capacity to improve quality of care remains contested. This narrative review explores what acute physicians require from electronic health record (EHR) systems, drawing on evidence from usability studies, implementation evaluations and quality frameworks. Despite substantial investment, evidence of benefits for clinical outcomes, cost-effectiveness and user satisfaction remains modest. There is limited research on impact on mortality, efficiency and patient experience. Most research demonstrates inconsistent effects on process and intermediate outcomes such as clinical documentation quality (legibility) or improvements in medication safety. Poor system design based on work as described/imagined, rather than work as actually done, contributes to clinician burnout and undermines system adoption. Despite this, the review identifies good practice examples that show the potential for transformation in this challenging area of medical care. Future progress depends on integrating human factors science, rigorous usability assessment and responsive design. Research will need to evidence equity and sustainability. Acute physicians should 'expect more': systems that provide the right information, in the right context, at the right time - first time.