title: Brief report: Failure of an electronic medical record tool to improve pain assessment documentation.
abstract: OBJECTIVE
  To comply with pain management standards, Bellevue Hospital in New York City implemented a mandatory computerized pain assessment screen (PAS) in its electronic medical record (EMR) system for every outpatient encounter. We assessed provider acceptance of the instrument and examined whether the intervention led to increased documentation of pain-related diagnoses or inquiries.
  
  
  METHODS
  Cross-sectional survey; a pre- and posthistorically controlled observational study.
  
  
  METHODS
  The utility of the computerized tool to medicine housestaff and attendings was assessed by an anonymous survey. We conducted an electronic chart review comparing all adult primary care patient encounters over a 2-day period 6 months prior to implementation of the PAS and on 2 days 6 months after its implementation.
  
  
  RESULTS
  Forty-seven percent of survey respondents felt that the computerized assessment tool was "somewhat difficult" or "very difficult" to use. The majority of respondents (79%) felt the tool did not change their pain assessment practice. Of 265 preintervention patients and 364 postintervention patients seen in the clinic, 42% and 37% had pain-related diagnoses, respectively (P=.29). Pain inquiry by the physician was noted for 49% of preintervention patients and 44% of the postintervention patients (P=.26). In 55% of postintervention encounters, there was discordance between the pain documentation using the PAS tool and the free text section of the medical note.
  
  
  CONCLUSIONS
  A mandatory computerized pain assessment tool did not lead to an increase in pain-related diagnoses and may have hindered the documentation of pain assessment because of the perceived burden of using the application.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, New York University School of Medicine, New York, NY, USA. osaigh@chpnet.org
authors.forename: Orit
authors.initials: O
authors.lastname: Saigh
authors.forename: Marc M
authors.initials: MM
authors.lastname: Triola
authors.forename: R Nathan
authors.initials: RN
authors.lastname: Link
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003625:Data Collection; D004282:Documentation / Q000379:methods*; D006801:Humans; D016347:Medical Records Systems, Computerized / Q000592:standards*; D010147:Pain Measurement; D011785:Quality Assurance, Health Care / Q000379:methods*