The electronic medical record and patient-centered care

Nusbaum, Neil J.

doi:10.5210/ojphi.v3i2.3721

Cited by 6 publications

(5 citation statements)

References 14 publications

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“…We designed our testing procedures of TOLF based on the guidelines that foster accessibility, convenience, and efficiency of mHealth system (35–39) to undergo evaluation with usability testing, psychometric research to evaluate the reliability, validity and efficiency of assessment instrument administered by TOLF and pilot feasibility testing of TOLF interventions. Testing reliability, validity, and efficiency of assessment instrument delivered by mHealth system is imperative as the changes of user environment using electronic device may lead to changes of validity and reliability even in the case of using already established validity and reliability in the paper-pencil format.…”

Section: Methodsmentioning

confidence: 99%

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mHealth self-care interventions: managing symptoms following breast cancer treatment

Fu¹,

Axelrod²,

Guth³

et al. 2016

mHealth

121

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Background Many women suffer from daily distressing symptoms related to lymphedema following breast cancer treatment. Lymphedema, an abnormal accumulation of lymph fluid in the ipsilateral body area or upper limb, remains an ongoing major health problem affecting more than 40% of 3.1 million breast cancer survivors in the United States. Patient-centered care related to lymphedema symptom management is often inadequately addressed in clinical research and practice. mHealth plays a significant role in improving self-care, patient-clinician communication, and access to health information. The-Optimal-Lymph-Flow health IT system (TOLF) is a patient-centered, web-and-mobile-based educational and behavioral mHealth interventions focusing on safe, innovative, and pragmatic electronic assessment and self-care strategies for lymphedema symptom management. The purpose of this paper is to describe the development and test of TOLF system. Methods The development of TOLF was guided by the Model of Self-Care for Lymphedema Symptom Management and designed based on principles fostering accessibility, convenience, and efficiency of mHealth system to enhance training and motivating assessment of and self-care for lymphedema symptoms. Test of TOLF was accomplished by conducting a psychometric study to evaluate reliability, validity, and efficiency of the electronic version of Breast Cancer and Lymphedema Symptom Experience Index (BCLE-SEI), a usability testing and a pilot feasibility testing of mHealth self-care interventions. Results Findings from the psychometric study with 355 breast cancer survivors demonstrated high internal consistency of the electronic version of the instrument: a Cronbach’s alpha coefficient of 0.959 for the total scale, 0.919 for symptom occurrence, and 0.946 for symptom distress. Discriminant validity of the instrument was supported by a significant difference in symptom occurrence (z=−6.938, P<0.000), symptom distress (z=−5.894, P<0.000), and total scale (z=−6.547, P<0.000) between breast cancer survivors with lymphedema and those without it. Findings of usability testing showed that breast cancer survivors were very satisfied with the mHealth self-care interventions: 90% rated the system having no usability problems; 10% noted minor cosmetic problems: spelling errors or text font size. The majority of participants 96.6% strongly agreed that the system was easy to use and effective in helping to learn about lymphedema, symptoms and self-care strategies. Feasibility testing demonstrated that a 12-week one group intervention using TOLF had significantly positive effects on less pain (P=0.031), less soreness (P=0.021), less aching (P=0.024), less tenderness (P=0.039), fewer numbers of lymphedema symptoms (P=0.003), and improved symptom distress (P=0.000) at 12 weeks after intervention. Themes from the qualitative data included empowerment, high quality information, loving avatar simulation videos, easy accessibility, and user-friendliness. Conclusions TOLF system using the electronic version of the ...

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Section: Methodsmentioning

confidence: 99%

“…We conducted usability testing of heuristic evaluation and end-user testing with breast cancer survivors on TOLF intervention (33–35). We recruited 30 English-speaking breast cancer survivors over 21 years of age who had the various experience of using internet to evaluate TOLF intervention from October to December 2014.…”

Section: Methodsmentioning

confidence: 99%

mHealth self-care interventions: managing symptoms following breast cancer treatment

Fu¹,

Axelrod²,

Guth³

et al. 2016

mHealth

121

View full text Add to dashboard Cite

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“…In addition, we examined references of prior review articles [16][17][18][19][20][21][22][23][24][25][26] and had two independent expert reviewers evaluate the results to ensure key articles were included. To explore publication bias, we reviewed meeting abstracts from two previous years of Society of General Internal Medicine, American Academy of Family Physicians and International Conference on Communication in Healthcare and European Association of Communication in Healthcare conferences for studies that may not have been published.…”

Section: Data Sources and Searchesmentioning

confidence: 99%

Impact of Electronic Medical Record Use on the Patient–Doctor Relationship and Communication: A Systematic Review

et al. 2016

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BACKGROUND: While Electronic Medical Record (EMR) use has increased dramatically, the EMR's impact on the patient-doctor relationship remains unclear. This systematic literature review sought to understand the impact of EMR use on patient-doctor relationships and communication.METHODS: Parallel searches in Ovid MEDLINE, PubMed, Scopus, PsycINFO, Cochrane Library, reference review of prior systematic reviews, meeting abstract reviews, and expert reviews from August 2013 to March 2015 were conducted. Medical Subject Heading terms related to EMR use were combined with keyword terms identifying face-to-face patient-doctor communication. English language observational or interventional studies were included. Studies examining physician attitudes only were excluded. Structured data extraction compared study population, design, data collection method, and outcomes. RESULTS: Fifty-three of 7445 studies reviewed met inclusion criteria. Included studies used behavioral analysis (28) to objectively measure communication behaviors using video or direct observation and pre-post or crosssectional surveys to examine patient perceptions (25). Objective studies reported EMR communication behaviors that were both potentially negative (i.e., interrupted speech, low rates of screen sharing) and positive (i.e., facilitating questions). Studies examining overall patient perceptions of satisfaction, communication or the patient-doctor relationship (n=22) reported no change with EMR use (16); a positive impact (5) or showed mixed results (1). Study quality was not assessable. Small sample sizes limited generalizability. Publication bias may limit findings. DISCUSSION: Despite objective evidence that EMR use may negatively impact patient-doctor communication, studies examining patient perceptions found no change in patient satisfaction or patient-doctor communication. Therefore, our findings should encourage providers to adopt the EMR as a communication tool. Future research is needed to better understand how to enhance patientdoctor-EMR communication. This research should correlate observed physician behavior to patient satisfaction, focus on physician communication skills training, and explore inpatient experiences.

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“…The dominance of the voice of the medicine in IBD specialist consultations has also been demonstrated by the structure of the visits centring around electronic medical records and a checklist of test results. 22 This is despite electronic medical records having the potential to be designed 33 or used 34 35 in a way that facilitates a patient-centred clinical encounter. What further strengthens the claim that the voice of the medicine is generally the dominant voice in IBD specialist consultations is that gastroenterologists in the USA asked patients about the impact of IBD on their quality of life or emotional well-being in less than a quarter of visits.…”

Section: Discussionmentioning

confidence: 99%

Clinical communication in inflammatory bowel disease: a systematic review of the study of clinician–patient dialogue to inform research and practice

et al. 2021

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ObjectivesThis systematic review aims to investigate what is currently known about the characteristics of interactions between patients with inflammatory bowel disease (IBD) and their clinicians and its effect on patient outcomes.Data sourcesScopus, PubMed, Embase, Communication Abstracts, Health & Society, Linguistics and Language Behaviour Abstracts and PsycINFO were systematically searched from inception to June 2021.Study eligibility criteriaPeer-reviewed journal articles and book chapters in English investigating the characteristics of naturally occurring interactions between clinicians that manage IBD and patients with IBD during recorded consultations were included.Study appraisal and synthesis methodsRisk of bias was assessed using a specifically developed quality assessment tool, grounded in linguistic theory and the Mixed Methods Appraisal Tool. A narrative synthesis guided by the linguistic concept of metafunction was performed to synthesise the findings.ResultsOf the 2883 abstracts reviewed five formed the basis of the review. Interactions between IBD nurses and patients have been mostly characterised in terms of information provision regarding prescribed medications without consideration of the interpersonal aspect. Discussing online medical information with nurses has been shown to improve patient satisfaction. Analyses of gastroenterologist–patient interactions have concentrated on the clinical relationship which has been shown to be disease-centred. Shared decision making in ulcerative colitis has been shown to be compromised due to lack of transparency regarding treatment goals.LimitationsThis review did not include articles in languages other than English. Cumulative evidence could not be produced due to the small number of included studies and the diversity of contexts, theories and data types.Conclusions and implications of key findingsThere is a paucity of systematic research on naturally occurring clinical communication in IBD and its effect on outcomes. Further research needs to be done to address this knowledge gap.PROSPERO registration numberCRD42020169657.

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The electronic medical record and patient-centered care

Cited by 6 publications

References 14 publications

mHealth self-care interventions: managing symptoms following breast cancer treatment

mHealth self-care interventions: managing symptoms following breast cancer treatment

Impact of Electronic Medical Record Use on the Patient–Doctor Relationship and Communication: A Systematic Review

Clinical communication in inflammatory bowel disease: a systematic review of the study of clinician–patient dialogue to inform research and practice

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