Patient-centered Care and Electronic Health Records: It's Still About the Relationship (original) (raw)

Abstract

Two of the most important developments in ambulatory practice over the past 20 years are the advent of patient and relationship-centered care (PRCC) and electronic health records (EHRs). PRCC focuses on communication among patient, families, and physicians. 1,2 EHRs use information technology to manage, store, and instantly make available clinical information. 3 These two approaches have rapidly become parts of the medical lexicon and have been characterized by two recent Institute of Medicine reports as standards of high-quality care. The literature is replete with studies that demonstrate the benefits of PRCC and EHRs in ambulatory care. For example, patient-centered partnerships have been shown to lead to better adherence with treatment plans. The richer, deeper relationships that this communication style engenders can also improve treatment outcomes and promote satisfaction with care. 6 As well, by attending to the social and cultural contexts of pa-tients' lives, the use of PRCC can enhance continuity of care. EHRs offer improved access to clinical data and the opportunity to more readily practice population-based medicine. They can help decrease medical errors. 8 Electronic reminders assist physicians in meeting evidence-based medicine care standards. EHRs also improve the coordination of care as patients move from inpatient to outpatient settings and transition back and forth between subspecialist and primary care offices. Given these advances, remarkably little is known about how PRCC and EHRs influence one another in the daily practice of medicine. Many questions exist. How will physicians already in practice integrate recommended PRCC and EHR practices into their existing approaches to conducting medical interviews? Similarly, how will new generations of computerliterate physicians practice medicine once exposed to the principles of PRCC? How, if at all, will PRCC and EHRs help physicians attend to the physical, emotional, and social needs of patients, efficiently and effectively, especially during the phase-in of these skill sets? With ever-increasing pressures on productivity, can we really expect physicians to value their patients' illness experiences over documenting in the EHR what is Two of the most important developments in ambulatory practice over the past 20 years are the advent of patient and relationship-centered care (PRCC) and electronic health records (EHRs). However, there is a large gap in knowledge and practice between PRCC and EHR use. We believe the integration of PRCC with EHRs has the potential to personalize care, improve population-based care, and increase patient involvement. To accomplish this, advanced practitioners from both computer-and communication-centric disciplines must work together to establish systems that work synergistically. Research examining how outstanding clinicians use EHRs is essential to establish best practice models of use. As well, clinicians must examine how they use EHRs in their communication with patients, become aware of when the EHR hinders the human connection and when it enhances it, and develop a repertoire for using it simultaneously with PRCC.

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