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Can you hear me now?
Hearing Loss not well documented in
Electronic Medical Records
Newswise — 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.
Researchers retrospectively screened the
charts of all patients (approximately 1,200)
who underwent audiometry (hearing testing)
in the audiology department at MA 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
http://www.MassEyeAndEar.org.
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