Improving Patient–Provider Communication and Therapeutic Practice Through Better Integration of Electronic Health Records in the Exam Room: A Pilot Study

Patel, Minal R.; Smith, A. W.; Leo, Harvey L.; Wu, Hao; Zheng, Kai

doi:10.1177/1090198118796879

Cited by 10 publications

(9 citation statements)

References 27 publications

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“…Further work is needed to understand how to tailor educational comics to different patient populations and clinical settings, such as the inpatient hospital environment, to effectively engage patients and physicians with the EHR. While this educational intervention targeted patients, it is also important to teach patient-centered EHR behaviors to physicians to promote patient-physician-EHR engagement [20][21][22][23][24][25][26]58,59], and these efforts should be pursued in tandem. Additionally, EHRs should evolve to account for user experience, patient health literacy levels, and language needs to help reduce the digital divide and health disparities [19,[60][61][62][63][64][65][66][67][68].…”

Section: Discussionmentioning

confidence: 99%

“…In a 2016 study on patient perceptions of physician EHR use in an academic primary care practice, patients were dissatisfied when physicians appeared more focused on the computer than on them and frustrated with lack of transparency and poor body positioning, which contributed to perceptions of decreased quality of care [7]. While best practices to promote patient-centered EHR use have been identified, most physicians and patients are unaware of these strategies to improve patient-physician-EHR communication [6,12,[20][21][22][23][24][25][26].…”

Section: Introductionmentioning

confidence: 99%

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Impact of an Educational Comic to Enhance Patient-Physician–Electronic Health Record Engagement: Prospective Observational Study (Preprint)

Alkureishi¹,

Johnson²,

Nichols³

et al. 2020

Preprint

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BACKGROUND Electronic health record (EHR) use can impede or augment patient-physician communication. However, little research explores the use of an educational comic to improve patient-physician-EHR interactions. OBJECTIVE To evaluate the impact of an educational comic on patient EHR self-advocacy behaviors to promote patient engagement with the EHR during clinic visits. METHODS We conducted a prospective observational study with adult patients and parents of pediatric patients at the University of Chicago General Internal Medicine (GIM) and Pediatric Primary Care (PPC) clinics. We developed an educational comic highlighting EHR self-advocacy behaviors and distributed it to study participants during check-in for their primary care visits between May 2017 and May 2018. Participants completed a survey immediately after their visit, which included a question on whether they would be interested in a follow-up telephone interview. Of those who expressed interest, 50 participants each from the adult and pediatric parent cohorts were selected at random for follow-up telephone interviews 8 months (range 3-12 months) post visit. RESULTS Overall, 71.0% (115/162) of adult patients and 71.6% (224/313) of pediatric parents agreed the comic encouraged EHR involvement. African American and Hispanic participants were more likely to ask to see the screen and become involved in EHR use due to the comic (adult P=.01, P=.01; parent P=.02, P=.006, respectively). Lower educational attainment was associated with an increase in parents asking to see the screen and to be involved (ρ=−0.18, P=.003; ρ=−0.19, P<.001, respectively) and in adults calling for physician attention (ρ=−0.17, P=.04), which was confirmed in multivariate analyses. Female GIM patients were more likely than males to ask to be involved (median 4 vs 3, P=.003). During follow-up phone interviews, 90% (45/50) of adult patients and all pediatric parents (50/50) remembered the comic. Almost half of all participants (GIM 23/50, 46%; PPC 21/50, 42%) recalled at least one best-practice behavior. At subsequent visits, adult patients reported increases in asking to see the screen (median 3 vs 4, P=.006), and pediatric parents reported increases in asking to see the screen and calling for physician attention (median 3 vs 4, Ps<.001 for both). Pediatric parents also felt that the comic had encouraged them to speak up and get more involved with physician computer use since the index visit (median 4 vs 4, P=.02) and that it made them feel more empowered to get involved with computer use at future visits (median 3 vs 4, P<.001). CONCLUSIONS Our study found that an educational comic may improve patient advocacy for enhanced patient-physician-EHR engagement, with higher impacts on African American and Hispanic patients and patients with low educational attainment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of an Educational Comic to Enhance Patient-Physician–Electronic Health Record Engagement: Prospective Observational Study (Preprint)

Alkureishi¹,

Johnson²,

Nichols³

et al. 2020

Preprint

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“…The authors created separate, deidentified practitioner and patient surveys from existing tools in published research. 11,[24][25][26] The authors collected demographic data via survey. Practitioners self-reported how frequently (never, rarely, occasionally, fairly often, very often, always) they used the following 8 EHR-specific skills thought to be associated with better patient experience: (1) ask the patient the reason for the visit before turning to the computer, (2) explain how the computer can help care for the patient, (3) ask the patient permission to use the computer during the visit, (4) position the computer so the patient could see the screen, (5) explain to the patient what you are doing on the computer, (6) let the patient look on to see what you are doing on the computer, (7) show the patient results or information on the computer, and (8) express to the patient that you think the computer is a positive thing.…”

Section: Surveysmentioning

confidence: 99%

“…3,[7][8][9][10] Entering health information, placing electronic orders, and retrieving results can be distracting to patients and practitioners. 11,12 When practitioners focus on their computer, dialog is easily disrupted and can lead to gaps in communication and patients feeling unheard. 13,14 For practitioners, the EHR has also been associated with workrelated dissatisfaction and burnout.…”

Section: Introductionmentioning

confidence: 99%

“…15 Experts have suggested that practitioners can mitigate the potentially negative effects of EHR use during clinical encounters by learning and using EHR-specific communication skills. 4,11,[16][17][18][19][20][21][22][23] To improve patient and practitioner experiences with the EHR, we sought to conduct an assessment of practitioner use of EHR communication skills, as well as patient and practitioner experiences and attitudes regarding EHR use during clinical encounters. In addition, we sought to determine whether suggested EHR-specific communication skills were associated with better patient and practitioner experiences.…”

Section: Introductionmentioning

confidence: 99%

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Use of the Electronic Health Record During Clinical Encounters: An Experience Survey

Meltzer

Vorseth²,

Croghan³

et al. 2022

Ann Fam Med

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PURPOSE Use of the electronic health record (EHR) during face-to-face clinical encounters affects communication, and prior research has been inconclusive regarding its effect. This survey study assessed health care practitioner use of EHR-specific communication skills and patient and practitioner experiences and attitudes regarding EHR use during clinical encounters.METHODS For this US-based study, we distributed previously validated surveys to practitioners and adult patients (aged >18 years) at academic primary care practices from July 1, 2018 through August 31, 2018. The electronic practitioner survey was completed first; a paper survey was administered to patients after appointments. Descriptive statistics were calculated, and the Cochran-Armitage test was used to assess for associations between key variables. RESULTSThe practitioner response was 72.9% (43/59); patient response, 45.2% (452/1,000). Practitioners reported maintaining less eye contact (79.1%), listening less carefully (53.5%), focusing less on patients (65.1%), and visits feeling less personal (62.8%). However, patients reported that practitioners provided sufficient eye contact (96.8%) and listened carefully (97.0%); they disagreed that practitioners focused less on them (86.7%) or that visits felt less personal (87.2%). Patients thought EHR use was positive (91.7%); only one-third of practitioners (37.2%) thought that patients would agree with that statement. Practitioners reported stress, burnout, and a lack of sufficient time for EHR documentation.CONCLUSIONS A discrepancy existed in this study between patient and practitioner experiences and attitudes about EHR use, which appeared to negatively affect the experience of health care practitioners but not patients. Organizations should adopt formal strategies to improve practitioner experiences with EHR use.

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Patient and family engagement in communicating with electronic medical records in hospitals: A systematic review

Manias

Bucknall

Wickramasinghe

et al. 2020

International Journal of Medical Informatics

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Improving Patient–Provider Communication and Therapeutic Practice Through Better Integration of Electronic Health Records in the Exam Room: A Pilot Study

Cited by 10 publications

References 27 publications

Impact of an Educational Comic to Enhance Patient-Physician–Electronic Health Record Engagement: Prospective Observational Study (Preprint)

Impact of an Educational Comic to Enhance Patient-Physician–Electronic Health Record Engagement: Prospective Observational Study (Preprint)

Use of the Electronic Health Record During Clinical Encounters: An Experience Survey

Patient and family engagement in communicating with electronic medical records in hospitals: A systematic review

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