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Touching Base with Paulina Sockolow

February 15, 2017

Paulina Sockolow, DrPH, an associate professor in Health Systems and Sciences Research, is the next guest lecturer in the BAYADA Home Health Care Speaker Series on February 22, 2017. She will present “Electronic Health Record Use in Home Care: Help or Hindrance?”  
Her presentation discusses two of her research studies. The first is a completed R21 study, a feasibility study, which looked at point of care electronic health records (EHR) to assess impact on the nurse care process, to see whether having the patient’s clinical information in electronic form at the point of care helps the nurse provide care or to see whether it is simply one more thing to do. This study found that clinician efficiency decreased while use of the EHR increased; however, there was a sustained increase in the timeliness of the documentation in the EHR which increased availability of the information and reduced the amount of time the clinician needed to locate it. 
The second is an R01 study, a large study, which Sockolow is currently conducting with collaborators Ellen Bass, PhD, who has a dual appointment in both CNHP and the College of Computing and Informatics, and Kathy Bowles PhD RN, at University of Pennsylvania School of Nursing. Together they identified four major decisions made when a patient is admitted, and they plan to assess whether the point of care EHR helps the clinician make those decisions more efficiently. “They’re under tremendous time constraints and the information is not always available to them,” said Sockolow. “We want to look at three diverse agencies: rural, suburban and urban. We’ve completed our observations at the rural site and are currently in the process of analyzing those findings.” 
Sockolow began her career as a project manager implementing clinical information systems in hospitals. She noticed that a tremendous amount of time, effort and resources were spent implementing these systems, and also that while physicians used the systems for several hours per day, nurses use them for their entire shift. Sockolow wanted to help streamline the process. “I went back to school to learn how to evaluate health information technology systems and focused my energies on looking at how nurses, occupational therapists and physical therapists use these systems which tend to be designed for physicians.” 
Changes to EHR systems are not taken lightly. Sockolow explained: “Consumer electronics are constantly updated. There are millions of users, and you need to compete for market share. Therefore, it’s usually fine-tuned to optimize the experience. On the other hand, software that’s developed for health care is a small specialized market, not a lucrative market at all, and it’s incredibly complex data. The user interface is a large investment both because of the sophistication of the work process and because any change in the user interface can’t be casual. Think about what happens when you upgrade your phone’s interface. You have trepidation of what’s going to change, how that’s going to impact your ability to manage for the next day or two. That’s what you think about. But a clinician who is dealing with a patient has to think about the care of the patient. If there’s a change to the user interface for the health information technology, it could potentially introduce opportunity for a patient safety error. So those changes to the user interface are made slower and more carefully than changes to consumer facing technology.”
Sockolow said she’s hoping to make a difference in the standards and incentives related to home care EHR. “I joined the College of Nursing and Health Professions so that I could have the opportunity to work more closely with clinicians as compared to information technology researchers, and that grounds my research a bit. Bass is a human factors researcher, which is the human computer interface. Working with her opened up a new avenue in my research such that we could do analysis from a difference perspective, from the human factors perspective, that’s in some ways more detailed,” said Sockolow.  “Working with clinicians, and having access to researchers in related fields, broadens and enriches the research."