Clinical Scorecard: Assessing the Degree of Fragmentation in Digital Health and Its Potential Effects on Antimicrobial Prescribing: A Rapid Evidence Review

At a Glance

Key Highlights

• 25% of patients treated by more than one NHS trust in 2017/2018.
• 9.1% of clinical encounters involved different electronic health record systems.
• Inappropriate antibiotic selection can lead to treatment failure and adverse drug events.
• Timely access to complete clinical histories is essential for safe prescribing.
• Digital health fragmentation may hinder antimicrobial stewardship objectives.

Guideline-Based Recommendations

Diagnosis

• Access to complete patient information is critical for diagnosing infections.

Management

• Prompt and appropriate antibiotic therapy is essential in suspected infections.

Monitoring & Follow-up

• Monitor the impact of digital health fragmentation on antimicrobial prescribing.

Risks

• Incomplete records may lead to broader-spectrum antibiotic prescribing.

Patient & Prescribing Data

Patients with infections managed across health and social care settings.

Access to previous microbiology results and antibiotic exposure is necessary for effective treatment.

Clinical Best Practices

• Ensure interoperability of electronic health record systems.
• Improve data availability and usability at the point of care.
• Implement antimicrobial stewardship programs to mitigate risks associated with prescribing.

Related Resources & Content

• Warren L, Clarke J, Darzi A. Measuring the scale of hospital health record system fragmentation in England.
• Baltas I, Stockdale T, Tausan M, et al. Impact of antibiotic timing on mortality from gram-negative bacteraemia.
• Bauer KA, Kullar R, Gilchrist M, File TM. Antibiotics and adverse events.
• Rawson TM, Wilson RC, O'Hare D, et al. Optimizing antimicrobial use.
• World Health Organization. Antibiotic use: target ≥70% of total antibiotic use being access group antibiotics.