How to Integrate the Electronic Health Record and Patient-Centered Communication Into the Medical Visit: A Skills-Based Approach

Duke, Pamela; Frankel, Richard M.; Reis, Shmuel

doi:10.1080/10401334.2013.827981

Cited by 106 publications

(110 citation statements)

References 52 publications

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“…Unfortunately, few physicians are formally taught how to use the EMR in a patient-centered way. [31][32][33][34][35][36] This study has implications for future design of communications curricula as well as the content of required EMR training at healthcare facilities. Our findings and best practices could be used to guide the development of a patient-centered EMR use curriculum for faculty and trainees.…”

Section: Discussionmentioning

confidence: 99%

Patient Perceptions of Electronic Medical Record Use by Faculty and Resident Physicians: A Mixed Methods Study

et al. 2016

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BACKGROUND: While concerns remain regarding Electronic Medical Records (EMR) use impeding doctor-patient communication, resident and faculty patient perspectives post-widespread EMR adoption remain largely unexplored. OBJECTIVE: We aimed to describe patient perspectives of outpatient resident and faculty EMR use and identify positive and negative EMR use examples to promote optimal utilization. DESIGN: This was a prospective mixed-methods study. PARTICIPANTS: Internal medicine faculty and resident patients at the University of Chicago's primary care clinic participated in the study. APPROACH: In 2013, one year after EMR implementation, telephone interviews were conducted with patients using open-ended and Likert style questions to elicit positive and negative perceptions of EMR use by physicians. Interview transcripts were analyzed qualitatively to develop a coding classification. Satisfaction with physician EMR use was examined using bivariate statistics. RESULTS: In total, 108 interviews were completed and analyzed. Two major themes were noted: (1) Clinical Functions of EMR and (2) Communication Functions of EMR; as well as six subthemes: (1a) Clinical Care (i.e., clinical efficiency), (1b) Documentation (i.e., proper record keeping and access), (1c) Information Access, (1d) Educational Resource, (2a) Patient Engagement and (2b) Physical Focus (i.e., body positioning). Overall, 85 % (979/1154) of patient perceptions of EMR use were positive, with the majority within the BClinical Care^subtheme (n = 218). Of negative perceptions, 66 % (115/175) related to the BCommunication Functions^theme, and the majority of those related to the BPhysical Focus^subtheme (n = 71). The majority of patients (90 %, 95/106) were satisfied with physician EMR use: 59 % (63/107) reported the computer had a positive effect on their relationship and only 7 % (8/108) reported the EMR made it harder to talk with their doctors. CONCLUSIONS: Despite concerns regarding EMRs impeding doctor-patient communication, patients reported largely positive perceptions of the EMR with many patients reporting high levels of satisfaction. Future work should focus on improving doctors Bphysical focus^when using the EMR to redirect towards the patient.KEY WORDS: electronic health records; patient-centered care; physician patient relations; communication skills.

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Section: Discussionmentioning

confidence: 99%

Patient Perceptions of Electronic Medical Record Use by Faculty and Resident Physicians: A Mixed Methods Study

et al. 2016

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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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“…Early work from Israel in the training and assessment area is encouraging. 5 Not to test prospective primary care physicians on their use of computers in the consultation is akin to not testing their ability to ask open questions or use a stethoscope.…”

Section: Getting On With Your Computer Is Associated With Job Satisfamentioning

confidence: 99%

Getting on with your computer is associated with job satisfaction in primary care: entrants to primary care should be assessed for their competency with electronic patient record systems

Lusignan¹,

Pearce²,

Munro³

2014

Journal of Innovation in Health Informatics

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Job satisfaction in primary care is associated with getting on with your computer. Many primary care professionals spend longer interacting with their computer than anything else in their day. However, the computer often makes demands rather than be an aid or supporter that has learned its user's preferences. The use of electronic patient record (EPR) systems is underrepresented in the assessment of entrants to primary care, and in definitions of the core competencies of a family physician/general practitioner. We call for this to be put right: for the use of the EPR to support direct patient care and clinical governance to be given greater prominence in training and assessment. In parallel, policy makers should ensure that the EPR system use is orientated to ensuring patients receive evidence-based care, and EPR system suppliers should explore how their systems might better support their clinician users, in particular learning their preferences.

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How to Integrate the Electronic Health Record and Patient-Centered Communication Into the Medical Visit: A Skills-Based Approach

Cited by 106 publications

References 52 publications

Patient Perceptions of Electronic Medical Record Use by Faculty and Resident Physicians: A Mixed Methods Study

Patient Perceptions of Electronic Medical Record Use by Faculty and Resident Physicians: A Mixed Methods Study

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

Getting on with your computer is associated with job satisfaction in primary care: entrants to primary care should be assessed for their competency with electronic patient record systems

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