title: A review of the empirical evidence of the value of structuring and coding of clinical information within electronic health records for direct patient care.
abstract: BACKGROUND
  The case has historically been presented that structured and/or coded electronic health records (EHRs) benefit direct patient care, but the evidence base for this is not well documented.
  
  
  METHODS
  We searched for evidence of direct patient care value from the use of structured and/or coded information within EHRs. We interrogated nine international databases from 1990 to 2011. Value was defined using the Institute of Medicine's six areas for improvement for healthcare systems: effectiveness, safety, patient-centredness, timeliness, efficiency and equitability. We included studies satisfying the Cochrane Effective Practice and Organisation of Care (EPOC) group criteria.
  
  
  RESULTS
  Of 5016 potentially eligible papers, 13 studies satisfied our criteria: 10 focused on effectiveness, with eight demonstrating potential for improved proxy and actual clinical outcomes if a structured and/or coded EHR was combined with alerting or advisory systems in a focused clinical domain. Three studies demonstrated improvement in safety outcomes. No studies were found reporting value in relation to patient-centredness, timeliness, efficiency or equitability.
  
  
  CONCLUSIONS
  We conclude that, to date, there has been patchy effort to investigate empirically the value from structuring and coding EHRs for direct patient care. Future investments in structuring and coding of EHRs should be informed by robust evidence as to the clinical scenarios in which patient care benefits may be realised.
authors.affiliation: Centre for Health Informatics and Multiprofessional Education, University College London, UK. d.kalra@ucl.ac.uk
authors.forename: Dipak
authors.initials: D
authors.lastname: Kalra
authors.forename: Bernard
authors.initials: B
authors.lastname: Fernando
authors.forename: Zoe
authors.initials: Z
authors.lastname: Morrison
authors.forename: Aziz
authors.initials: A
authors.lastname: Sheikh
mesh_terms: D059019:Clinical Coding; D003695:Delivery of Health Care / Q000592:standards*; D057286:Electronic Health Records / Q000592:standards*; D055317:Evidence-Based Practice; D006801:Humans; D008490:Medical Informatics; D011320:Primary Health Care