Does sharing the electronic health record in the consultation enhance patient involvement? A mixed‐methods study using multichannel video recording and in‐depth interviews in primary care

Abstract

BackgroundSharing the electronic health‐care record (EHR) during consultations has the potential to facilitate patient involvement in their health care, but research about this practice is limited.MethodsWe used multichannel video recordings to identify examples and examine the practice of screen‐sharing within 114 primary care consultations. A subset of 16 consultations was viewed by the general practitioner and/or patient in 26 reflexive interviews. Screen‐sharing emerged as a significant theme and was explored further in seven additional patient interviews. Final analysis involved refining themes from interviews and observation of videos to understand how screen‐sharing occurred, and its significance to patients and professionals.ResultsEighteen (16%) of 114 videoed consultations involved instances of screen‐sharing. Screen‐sharing occurred in six of the subset of 16 consultations with interviews and was a significant theme in 19 of 26 interviews. The screen was shared in three ways: ‘convincing’ the patient of a diagnosis or treatment; ‘translating’ between medical and lay understandings of disease/medication; and by patients ‘verifying’ the accuracy of the EHR. However, patients and most GPs perceived the screen as the doctor's domain, not to be routinely viewed by the patient.ConclusionsScreen‐sharing can facilitate patient involvement in the consultation, depending on the way in which sharing comes about, but the perception that the record belongs to the doctor is a barrier. To exploit the potential of sharing the screen to promote patient involvement, there is a need to reconceptualise and redesign the EHR.

The Role of Hospital Inpatients in Supporting Medication Safety: A Qualitative Study

“…Paper based versus electronic prescribing seemed to have some effect on patients’ access to medication records as electronic records could only be accessed via a healthcare professional, whereas paper based records were often potentially available to patients at the end of their bed. Similarly, a mixed-methods study using multichannel video recording and in-depth interviews in UK primary care found that none of the available electronic systems consider or accommodate the possibility that patients may ‘share the screen’ with the healthcare professional [ 29 ]. In the UK inpatient setting, Lee et al [ 30 ] found that the computer screen was virtually invisible to inpatients and that the lack of a physical presence of a drug chart could prevent patients being involved with their medication.…”

“…However, the way in which healthcare professionals share and use medication records within patient consultations was also an important factor. Milne et al [ 29 ] identified three ways in which healthcare professionals share healthcare records with patients: convincing, translating and verifying. In the current study, on the rare occasions where the medication record was shared with patients during consultations, this was done for the purpose of “convincing” patients to take the medication prescribed by the doctors, rather than helping patients and healthcare professionals reach a shared understanding (translating) or enabling patients to question the medication they had been prescribed (verifying).…”

Patient involvement and institutional logics: A discussion paper

“…The research covers a wide range of topics, such as definitions of the concept of patient involvement, the importance of patient involvement, factors influencing patient participation in healthcare decisions, methods employed in the patient participation process, patient participation tools and techniques as well as the consequences, both beneficial and potentially detrimental, of patient participation in healthcare decision‐making (Shaghayegh, Hamzehgardeshi, Hessam, & Hamzehgardeshi, ). We have examined studies that pay great attention to exploring different parties’ understanding of patient involvement (Arnetz & Zhdanova, ; Luttik et al., ; O'Brien et al., ; Rise et al., ; VIBIS, , ) and in developing methods and testing tools to facilitate patient involvement, such as decision aids (Wood, Phillips, Edwards, & Glyn, ), patient information (Grime & Dudley, ), guidelines (Miller & Rollnick, ), electronic health records (Milne et al., ) and smartphone applications (Lalloo, Jibb, Rivera, Agarwal, & Stinson, ). Also literature on evaluating patient involvement is growing (Gibson, Welsman, & Britten, ), just like philosophical (Määttä, Lützén, & Öresland, ) and critical perspectives (Handberg, Beedholm, Bregnballe, Nellemann, & Seibæk, ; O'Shea, Chambers, & Boaz, ) on the topic.…”

<p>The role of medical data in efficient patient care delivery: a review</p>

“…This helps to make an accurate diagnosis and decision making22 by reducing the access time and use 1,2. Notification signal flags or BPAs prompt about “what content” and “with whom” to share23–25 that trigger potential adverse events (AEs) using easily identifiable displays that alert patient records reviewers 26. This enhances patient’s engagement in health care service provision27 and decision-making processes,28 as it builds trust29 and confidence30 that helps to identify specific and actionable adherence barriers 31.…”