Patient Perceptions of Electronic Medical Record Use by Faculty and Resident Physicians: A Mixed Methods Study

Abstract

BACKGROUND: While concerns remain regarding Electronic Medical Records (EMR) use impeding doctor-patient communication, resident and faculty patient perspectives post-widespread EMR adoption remain largely unexplored. OBJECTIVE: We aimed to describe patient perspectives of outpatient resident and faculty EMR use and identify positive and negative EMR use examples to promote optimal utilization. DESIGN: This was a prospective mixed-methods study. PARTICIPANTS: Internal medicine faculty and resident patients at the University of Chicago's primary care clinic participated in the study. APPROACH: In 2013, one year after EMR implementation, telephone interviews were conducted with patients using open-ended and Likert style questions to elicit positive and negative perceptions of EMR use by physicians. Interview transcripts were analyzed qualitatively to develop a coding classification. Satisfaction with physician EMR use was examined using bivariate statistics. RESULTS: In total, 108 interviews were completed and analyzed. Two major themes were noted: (1) Clinical Functions of EMR and (2) Communication Functions of EMR; as well as six subthemes: (1a) Clinical Care (i.e., clinical efficiency), (1b) Documentation (i.e., proper record keeping and access), (1c) Information Access, (1d) Educational Resource, (2a) Patient Engagement and (2b) Physical Focus (i.e., body positioning). Overall, 85 % (979/1154) of patient perceptions of EMR use were positive, with the majority within the BClinical Care^subtheme (n = 218). Of negative perceptions, 66 % (115/175) related to the BCommunication Functions^theme, and the majority of those related to the BPhysical Focus^subtheme (n = 71). The majority of patients (90 %, 95/106) were satisfied with physician EMR use: 59 % (63/107) reported the computer had a positive effect on their relationship and only 7 % (8/108) reported the EMR made it harder to talk with their doctors. CONCLUSIONS: Despite concerns regarding EMRs impeding doctor-patient communication, patients reported largely positive perceptions of the EMR with many patients reporting high levels of satisfaction. Future work should focus on improving doctors Bphysical focus^when using the EMR to redirect towards the patient.KEY WORDS: electronic health records; patient-centered care; physician patient relations; communication skills.

Time Spent on Dedicated Patient Care and Documentation Tasks Before and After the Introduction of a Structured and Standardized Electronic Health Record

“…This, however, can lead to patients having the feeling that the physician does not adequately pay attention to them. 3 Physicians want to keep the percentage of work that is spent on documentation tasks as low as possible. 4 More and more health care organizations want physicians to document data in an EHR in a standardized and structured way at the point of care.…”

Impact of a brief faculty training to improve patient-centered communication while using electronic health records

“…In 2015, the authors adapted a student curriculum on patient-centered EHR use to meet the needs of faculty providers [20][21][22]. The faculty workshop consisted of a lecture and a GOSCE.…”

A Comparison of Electronic Patient-Portal Use Among Patients with Resident and Attending Primary Care Providers

“…29 Another study of patient-reported satisfaction with electronic health record (EHR) use during a clinic visit showed patients had higher overall satisfaction with attending physician use of the EHR compared to resident physician use. 30 Efforts to increase patient use of portals may also need to keep in mind physician comfort with portal use. Similarly deserving of future investigation is addressing potential resident concerns about competency handling portal messages and the need for attending backup for complex virtual patient encounters.…”