Improving patient-centered communication while using an electronic health record: Report from a curriculum evaluation (original) (raw)
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Patient education and counseling, 2018
Despite rapid EHR adoption, few faculty receive training in how to implement patient-centered communication skills while using computers in exam rooms. We piloted a patient-centered EHR use training to address this issue. Faculty received four hours of training at Cleveland Clinic and a condensed 90-minute version at the University of Chicago. Both included a lecture and a Group-Objective Structured Clinical Exam (GOSCE) experience. Direct observations of 10 faculty in their clinical practices were performed pre- and post-workshop. Thirty participants (94%) completed a post-workshop evaluation assessing knowledge, attitude, and skills. Faculty reported that training was important, relevant, and should be required for all providers; no differences were found between longer versus shorter training. Participants in the longer training reported higher GOSCE efficacy, however shorter workshop participants agreed more with the statement that they had gained new knowledge. Faculty improved...
Patient-centered communication in the era of electronic health records: What does the evidence say?
Patient Education and Counseling, 2017
Patient-physician communication is essential for patient-centered health care. Physicians are concerned that electronic health records (EHRs) negatively affect communication with patients. This study identified a framework for understanding communication functions that influence patient outcomes. We then conducted a systematic review of the literature and organized it within the framework to better understand what is known. Method: A comprehensive search of three databases (CINAHL, Medline, PsycINFO) yielded 41 articles for analysis. Results: Results indicated that EHR use improves capture and sharing of certain biomedical information. However, it may interfere with collection of psychosocial and emotional information, and therefore may interfere with development of supportive, healing relationships. Patient access to the EHR and messaging functions may improve communication, patient empowerment, engagement, and self-management. Conclusion: More rigorous examination of EHR impacts on communication functions and their influences on patient outcomes is imperative for achieving patient-centered care. By focusing on the role of communication functions on patient outcomes, future EHRs can be developed to facilitate care. Practice implications: Training alone is likely to be insufficient to address disruptions to communication processes. Processes must be improved, and EHRs must be developed to capture useful data without interfering with physicians' and patients' abilities to effectively communicate.
BMC family practice, 2017
The Electronic Health Record (EHR) is now widely used in clinical encounters. Because its use can negatively impact the physician-patient relationship, several recommendations on the "patient-centered" use of the EHR have been published. However, the impact of training to improve EHR use during clinical encounters is not well known. The aim of this study was to assess the impact of training on residents' EHR-related communication skills and explore whether they varied according to the content of the consultation. We conducted a pre-post intervention study at the Primary Care Division of the Geneva University Hospitals, Switzerland. Residents were invited to attend a 3-month training course that included 2 large group sessions and 2-4 individualized coaching sessions based on videotaped encounters. Outcomes were: 1) residents' perceptions regarding the use of EHR, measured through a self-administered questionnaire and 2) objective use of the EHR during the first 10 ...
Patient-centered Care and Electronic Health Records: It's Still About the Relationship
Fam Med, 2010
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.
Communication and the electronic health record training: a comparison of three healthcare systems
Informatics in Primary Care, 2013
Background The electronic health record (EHR) used in the examination room, is becoming the primary method of medical data storage in primary care practice in the USA. One of the challenges in using EHRs is maintaining effective patient-provider communication. Many studies have focused on communication in the examination room. Purpose Scant research exists on the best methods in educating nurse practitioners and other primary care providers (clinicians). The purpose of this study was to explore various health record training programmes for clinicians. Methods One researcher participated in and observed three health systems' EHR training programmes for ambulatory care providers in the Pacific Northwest. A focused ethnographic approach was used, emphasising patient-provider communication. Results Only one system had formalised communication training in their class, the other two systems emphasised only the software and data aspects of the EHR. Conclusions The fact that clinicians are expected to use EHRs in the examination room necessitates the inclusion of communication training in EHR training programmes and/or as a part of primary care nurse practitioner education programmes.
Patient Education and Counseling, 2014
Objective-The computer with the electronic health record (EHR) is an additional 'interactant' in the medical consultation, as clinicians must simultaneously or in alternation engage patient and computer to provide medical care. Few studies have examined how clinicians' EHR workflow (e.g., gaze, keyboard activity, and silence) influences the quality of their communication, the patient's involvement in the encounter, and conversational control of the visit. Methods-Twenty-three primary care providers (PCPs) from USA Veterans Administration (VA) primary care clinics participated in the study. Up to 6 patients per PCP were recruited. The proportion of time PCPs spent gazing at the computer was captured in real time via videorecording. Mouse click/scrolling activity was captured through Morae, a usability software that logs mouse clicks and scrolling activity. Conversational silence was coded as the proportion of time in the visit when PCP and patient were not talking. After the visit, patients completed patient
Journal of the American Medical Informatics Association : JAMIA, 2015
The effects of electronic health records (EHRs) on doctor-patient communication are unclear. To evaluate the effects of EHR use compared with paper chart use, on novice physicians' communication skills. Within-subjects randomized controlled trial using observed structured clinical examination methods to assess the impact of use of an EHR on communication. A large academic internal medicine training program. First-year internal medicine residents. Residents interviewed, diagnosed, and initiated treatment of simulated patients using a paper chart or an EHR on a laptop computer. Video recordings of interviews were rated by three trained observers using the Four Habits scale. Thirty-two residents completed the study and had data available for review (61.5% of those enrolled in the residency program). In most skill areas in the Four Habits model, residents performed at least as well using the EHR and were statistically better in six of 23 skills areas (p<0.05). The overall average...
Clinician documentation of patient centered care in the electronic health record
BMC Medical Informatics and Decision Making, 2022
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 analysi...
Journal of Evaluation in Clinical Practice, 2009
Rationale, aims and objective The effect of Electronic Medical Record (EMR) use on Patient-Doctor Communication (PDC) has rarely been studied. As data accumulate, the purpose of this article is to review the literature on EMR effect on PDC, to identify recurring themes and to offer preliminary guidelines and future directions for medical education and research. Method A database search was conducted and 14 articles that met inclusion criteria (published in the past 10 years, empirical investigations, direct assessment of the EMR impact on patient-doctor communication) were selected for review. A qualitative, grounded theory-like approach was employed to analyse the data. Results EMR use often has a positive impact on information exchange, but exerts a negative influence on patient centredness. Some physician characteristics such as their computer skills and behavioural style assist in overcoming this negative influence. Conclusion The use of EMR exerts both positive and negative impacts on physicianpatient relationships. The negative impacts can be overcome by some simple means as well as better designs of EMR systems and medical education interventions. Physicians' everyday practices of integrating EMR use into the clinical encounter as well as better design of EMR systems and EMR and communication training may facilitate PDC in computerized settings.