Patient-centered care and the electronic health record: exploring functionality and gaps

Butler, Jorie; Gibson, Bryan; Lewis, Lacey; Reiber, Gayle E.; Kramer, Heidi; Rupper, Rand; Herout, Jennifer; Long, Brenna; Massaro, David; Nebeker, Jonathan R.

doi:10.1093/jamiaopen/ooaa044

Cited by 17 publications

(16 citation statements)

References 32 publications

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“…Data collection relies on manual review and abstraction of clinical data entered as a byproduct of routine patient care. We know that EHRs currently are not designed to document patient goals or other PCC information as structured data [ 3 ]. Future EHR design should address this gap by incorporating structured documentation of patient goals, patient voice and patient preferences; making this information easily searchable might both facilitate the delivery of PCC by providers and the measurement of PCC by health systems.…”

Section: Discussionmentioning

confidence: 99%

“…Patient Centered Care (PCC) involves treating the patient as a whole person and engaging the patient in their care [ 1 ]. PCC encompasses a broad set of concepts and actvities including (1) activation (involving patients in care, information and goal sharing) (2) relationship building (thoughtful communication, information sharing), and (3) shared decisions (collaborating and incorporating patient preferences at all levels of healthcare delivery) [ 2 , 3 ]. PCC is a central value in medicine, considered by the National Academy of Medicine to be on par with safety, effectiveness and equity [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…Clinical notes may be an important indicator of provider conceptions of the patient including patient activation, patient goals and preferences, patient "voice" (quotes from patients in notes), and informational priorities. However, because this information is not currently recorded as structured data within the electronic health record (EHR), it can be challenging to measure the extent to which PCC occurs in clinical practice [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

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Clinician documentation of patient centered care in the electronic health record

Butler

Gibson

Patterson

et al. 2022

BMC Med Inform Decis Mak

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Background In this study we sought to explore the possibility of using patient centered care (PCC) documentation as a measure of the delivery of PCC in a health system. Methods We first selected 6 VA medical centers based on their scores for a measure of support for self-management subscale from a national patient satisfaction survey (the Survey for Healthcare Experience-Patients). We accessed clinical notes related to either smoking cessation or weight management consults. We then annotated this dataset of notes for documentation of PCC concepts including: patient goals, provider support for goal progress, social context, shared decision making, mention of caregivers, and use of the patient's voice. We examined the association of documentation of PCC with patients’ perception of support for self-management with regression analyses. Results Two health centers had < 50 notes related to either tobacco cessation or weight management consults and were removed from further analysis. The resulting dataset includes 477 notes related to 311 patients total from 4 medical centers. For a majority of patients (201 out of 311; 64.8%) at least one PCC concept was present in their clinical notes. The most common PCC concepts documented were patient goals (patients n = 126; 63% clinical notes n = 302; 63%), patient voice (patients n = 165, 82%; clinical notes n = 323, 68%), social context (patients n = 105, 52%; clinical notes n = 181, 38%), and provider support for goal progress (patients n = 124, 62%; clinical notes n = 191, 40%). Documentation of goals for weight loss notes was greater at health centers with higher satisfaction scores compared to low. No such relationship was found for notes related to tobacco cessation. Conclusion Providers document PCC concepts in their clinical notes. In this pilot study we explored the feasibility of using this data as a means to measure the degree to which care in a health center is patient centered. Practice Implications: clinical EHR notes are a rich source of information about PCC that could potentially be used to assess PCC over time and across systems with scalable technologies such as natural language processing.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinician documentation of patient centered care in the electronic health record

Butler

Gibson

Patterson

et al. 2022

BMC Med Inform Decis Mak

Self Cite

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“…Aligning care to understand and address individual goals and preferences has been described as true north in high-quality care 41 and is foundational in efforts to broaden the orientation of care delivery from remediating medical problems in isolation (particularly challenging for those with MCC) to a broader whole-person perspective; this latter approach requires engagement of individuals as partners in care. 42 Although a wide range of patient-and clinician-facing strategies have been developed to set the stage for shared decision making and person-centered care planning, 39,43,44 evidence-based approaches and measures to enable the systematic elicitation and actualization of goal-based care remain underdeveloped. 45,46 The emergence of consumer-facing health information technology poses interesting possibilities for goal-oriented care by enabling the active participation of individuals, families, and clinicians in the process of documenting information about care goals in a way that accessible to the wide range of involved actors.…”

Section: Goal-based Care: Engaging Individuals In Identifying and Achieving Outcomes That Mattermentioning

confidence: 99%

A scoping review of person and family engagement in the context of multiple chronic conditions

Vick

Wolff

2021

Health Services Research

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Objective To review definitions, concepts, and evidence regarding person and family engagement for persons with multiple chronic conditions (MCCs) in order to identify opportunities to advance the field. Data Source Ovid MEDLINE. Study Design We performed a two‐step process as follows: (1) a critical review of conceptual models of engagement to identify key concepts most pertinent to engagement among persons with MCC as a “launch pad” to our scoping review and (2) a scoping review of reviews of engagement for persons living with MCC. Data Collection/Extraction Methods First, we critically reviewed six models of engagement. Second, our scoping review identified 1297 citations, with 67 articles meeting criteria for inclusion. Of these, we focused on reviews, of which there were nine titles/abstracts retained for full‐text consideration. Six full‐text reviews were included in the final analysis. The purpose, review type, population, number/type of included studies, theoretical framework, and findings of each study were extracted and analyzed thematically. Principal Findings Conceptual models of engagement differ with respect to areas of emphasis (e.g., systems or clinical encounters) as well as attention to vulnerable populations, involvement of family, consideration of cost–benefit trade‐offs, and attention to outcomes that matter most. Our scoping review of reviews identified just one article explicitly focused on engagement interventions for those with MCC. Other reviews examined elements of self‐management and involvement in decision making, conceptually related to engagement without explicit use of the word. We find that existing evidence has predominantly described individual‐level strategies rather than targeting organizations, systems, or policies. Barriers to engagement are not well described nor are potential downsides to engagement. Family engagement is rarely considered. Conclusions Promising areas of future work include attention to barriers to engagement including trust, goal‐based care, the design of structural changes to care delivery, trade‐offs between benefits and costs, and family engagement.

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“…In today’s health care environment, human-centered design methods are increasingly preferred for designing technology interventions that fit with workflow, 4 especially when patients are potential consumers of the information. 5 , 6 This review examines the available evidence to guide the design and implementation of predictive risk information sharing with patients.…”

Section: Introductionmentioning

confidence: 99%

Risky business: a scoping review for communicating results of predictive models between providers and patients

et al. 2021

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Objective Given widespread excitement around predictive analytics and the proliferation of machine learning algorithms that predict outcomes, a key next step is understanding how this information is—or should be—communicated with patients. Materials and Methods We conducted a scoping review informed by PRISMA-ScR guidelines to identify current knowledge and gaps in this domain. Results Ten studies met inclusion criteria for full text review. The following topics were represented in the studies, some of which involved more than 1 topic: disease prevention (N = 5/10, 50%), treatment decisions (N = 5/10, 50%), medication harms reduction (N = 1/10, 10%), and presentation of cardiovascular risk information (N = 5/10, 50%). A single study included 6- and 12-month clinical outcome metrics. Discussion As predictive models are increasingly published, marketed by industry, and implemented, this paucity of relevant research poses important gaps. Published studies identified the importance of (1) identifying the most effective source of information for patient communications; (2) contextualizing risk information and associated design elements based on users’ needs and problem areas; and (3) understanding potential impacts on risk factor modification and behavior change dependent on risk presentation. Conclusion An opportunity remains for researchers and practitioners to share strategies for effective selection of predictive algorithms for clinical practice, approaches for educating clinicians and patients in effectively using predictive data, and new approaches for framing patient-provider communication in the era of artificial intelligence.

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Patient-centered care and the electronic health record: exploring functionality and gaps

Cited by 17 publications

References 32 publications

Clinician documentation of patient centered care in the electronic health record

Clinician documentation of patient centered care in the electronic health record

A scoping review of person and family engagement in the context of multiple chronic conditions

Risky business: a scoping review for communicating results of predictive models between providers and patients

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