Learning to use electronic health records: can we stay patient-centered? A pre-post intervention study with family medicine residents

Lanier, Cédric; Dao, Melissa Dominicé; Hudelson, Patricia; Cerutti, Bernard; Perron, Noëlle Junod

doi:10.1186/s12875-017-0640-2

Cited by 12 publications

(16 citation statements)

References 52 publications

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“…Further work is needed to understand how to tailor educational comics to different patient populations and clinical settings, such as the inpatient hospital environment, to effectively engage patients and physicians with the EHR. While this educational intervention targeted patients, it is also important to teach patient-centered EHR behaviors to physicians to promote patient-physician-EHR engagement [ 20 - 26 , 58 , 59 ], and these efforts should be pursued in tandem. Additionally, EHRs should evolve to account for user experience, patient health literacy levels, and language needs to help reduce the digital divide and health disparities [ 19 , 60 - 68 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of an Educational Comic to Enhance Patient-Physician–Electronic Health Record Engagement: Prospective Observational Study

et al. 2021

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Background Electronic health record (EHR) use can impede or augment patient-physician communication. However, little research explores the use of an educational comic to improve patient-physician-EHR interactions. Objective To evaluate the impact of an educational comic on patient EHR self-advocacy behaviors to promote patient engagement with the EHR during clinic visits. Methods We conducted a prospective observational study with adult patients and parents of pediatric patients at the University of Chicago General Internal Medicine (GIM) and Pediatric Primary Care (PPC) clinics. We developed an educational comic highlighting EHR self-advocacy behaviors and distributed it to study participants during check-in for their primary care visits between May 2017 and May 2018. Participants completed a survey immediately after their visit, which included a question on whether they would be interested in a follow-up telephone interview. Of those who expressed interest, 50 participants each from the adult and pediatric parent cohorts were selected at random for follow-up telephone interviews 8 months (range 3-12 months) post visit. Results Overall, 71.0% (115/162) of adult patients and 71.6% (224/313) of pediatric parents agreed the comic encouraged EHR involvement. African American and Hispanic participants were more likely to ask to see the screen and become involved in EHR use due to the comic (adult P=.01, P=.01; parent P=.02, P=.006, respectively). Lower educational attainment was associated with an increase in parents asking to see the screen and to be involved (ρ=−0.18, P=.003; ρ=−0.19, P<.001, respectively) and in adults calling for physician attention (ρ=−0.17, P=.04), which was confirmed in multivariate analyses. Female GIM patients were more likely than males to ask to be involved (median 4 vs 3, P=.003). During follow-up phone interviews, 90% (45/50) of adult patients and all pediatric parents (50/50) remembered the comic. Almost half of all participants (GIM 23/50, 46%; PPC 21/50, 42%) recalled at least one best-practice behavior. At subsequent visits, adult patients reported increases in asking to see the screen (median 3 vs 4, P=.006), and pediatric parents reported increases in asking to see the screen and calling for physician attention (median 3 vs 4, Ps<.001 for both). Pediatric parents also felt that the comic had encouraged them to speak up and get more involved with physician computer use since the index visit (median 4 vs 4, P=.02) and that it made them feel more empowered to get involved with computer use at future visits (median 3 vs 4, P<.001). Conclusions Our study found that an educational comic may improve patient advocacy for enhanced patient-physician-EHR engagement, with higher impacts on African American and Hispanic patients and patients with low educational attainment.

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Section: Discussionmentioning

confidence: 99%

Impact of an Educational Comic to Enhance Patient-Physician–Electronic Health Record Engagement: Prospective Observational Study

et al. 2021

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“…35,36 A decrease in visual contact while using EHR does not seem to be necessarily related with patients dissatisfaction 48 and it is not clear whether visual contact has a superior "value" over verbal contact during physician-patient interaction . 13,32,49,50 In our study, almost a third of patients preferred verbal contact alone while using EHR. Talking to patients while entering or extracting data seems to compensate for the decrease in visual contact 35 , especially if physicians summarize patients' information or explain what they are doing while typing.…”

Section: Visual and Verbal Contact Maintains The Fluency Of The Conversationmentioning

confidence: 55%

“…[26][27][28] Despite the apparent effectiveness of such training, medical students and physicians remain insufficiently trained in how to use EHR in a patient-centered way . [29][30][31][32] To date, studies have mostly surveyed patients' satisfaction regarding physicians' ways of using the computer. They have also explored the functions and roles physicians attribute to the computer .…”

Section: Introductionmentioning

confidence: 99%

How Do Patients Want Us to Use the Computer During Medical Encounters?—A Discrete Choice Experiment Study

Lanier

Dao

Baer³

et al. 2021

J GEN INTERN MED

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Background Primary care physicians (PCPs) now widely use electronic health records (EHRs) during medical encounters. Experts in clinical communication issued recommendations for a patient-centered use of EHRs. However, they have never been validated by patients themselves. Objective To explore patients’ preferences regarding physicians’ EHR-related behaviors. Design Discrete choice experiment study. Patients French-speaking patients waiting for a medical consultation at two outpatient clinics in Geneva, Switzerland. Main Measures We invited patients to watch videos displaying 2 or 3 variations of four specific EHR-related behaviors and asked them to indicate which one they preferred. EHR-related behaviors were (1) typing: continuous/intermittent/handwriting in biomedical or psychosocial focused consultations; (2) maintaining contact while typing: visual/verbal/both; (3) signposting the use of EHR: with/without; (4) position of physicians’ hands and bust: on the keyboard and towards the patient/away from the keyboard and towards the patient/on the keyboard and towards the screen. Key Results Three hundred thirty-six patients participated (response rate 61.4%). They preferred intermittent typing versus handwriting or continuous typing for biomedical issues (32.7%; 95% CI: 26.0–40.2% vs 31.6%; 95% CI: 24.9–39.0% or 14.9%; 95% CI: 10.2–21.1%) and psychosocial issues (38.7%; 95% CI: 31.6–46.3% vs 24.4% 95% CI: 18.4–31.5% or 17.9%; 95% CI; 12.7–24.4%). They favored visual and verbal contact (38.9%; 95% CI: 31.9–46.3%) over verbal (30.3%; 95% CI: 23.9–37.5%) or visual contact only (11.4%; 95% CI: 7.5–17.1%) while the doctor was typing. A majority preferred signposting the use of EHR versus no signposting (58.9%; 95% CI: 53.5–64.0% vs 34.8%; 95% CI: 29.9–40.1%). Finally, half of the patients (49.7%; 95% CI: 42.0–57.4%) favored the position with the physician’s bust towards the patient and hands away from the keyboard. Conclusions Our study shows that patients’ preferences regarding EHR-related behaviors are in line with most experts’ recommendations. Such recommendations should be more consistently integrated into under- and postgraduate communication skills training.

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“…We conducted secondary analyses of data from a larger study that assessed the impact of a training program on residents’ use of the EHR during the clinical encounter. 24 It was conducted at the Primary Care Division of the Geneva University Hospitals, Switzerland. The Primary Care Division has an outpatient clinic providing care to a diverse and vulnerable urban patient population.…”

Section: Methodsmentioning

confidence: 99%

“… 25 A coding scheme based on an initial analysis of 15 videotaped encounters and a review of the literature was used to code the EHR use during the first 10 minutes of the clinical encounter. 24 A researcher from “Entre les lignes Inc.” coded the EHR use linked to the RIAS utterances. In this secondary analysis, use of EHR was defined as the percentage of utterances for which either the keyboard and/or the screen gaze had been used (continuous variable).…”

Section: Methodsmentioning

confidence: 99%

What factors influence the use of electronic health records during the first 10 minutes of the clinical encounter?

Lanier¹,

Cerutti²,

Dao

et al. 2018

IJGM

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PurposeThe use of electronic health records (EHRs) by physicians during the consultation is common and can be problematic. Factors influencing the use of EHRs during clinical encounters include physician and patient characteristics, consultation type as well as spatial organization of the room and type of EHR template. Their relative importance is however not well known. This study aimed to explore to what extent several physician, patient and consultation factors were associated with EHR use during the first 10 minutes of primary care consultations.MethodsWe examined EHR use of 17 residents in 142 videotaped consultations at the Primary Care Division of the Geneva University Hospitals, Switzerland. We conducted univariable and multivariable analyses with patient, physician and consultation variables to predict EHR use: sex and age of the patient; physician’s sex, age, postgraduate experience and EHR-use self-perception; and language, type of consultation (new/follow-up) and content of the consultation using the Roter interaction analysis system (RIAS), the main variable being the percentage of utterances in relation to EHR use during the first 10 minutes.ResultsMale physicians (residents) and those with less clinical experience and conducting a new consultation or addressing biomedical content were positively correlated with EHR use (+5.3% for male physicians, P=0.101; +0.6% per year of experience, P=0.021; +6.0% for new consultation, P=0.097; +0.4% per 1% of biomedical content increase; P=0.018).ConclusionOnly a small number of physician, patient and consultation factors appear to have an impact on the use of EHR during primary care consultations, and this impact remains modest. Given the influence of EHR use on physician–patient relationship, further research should explore what other factors are implicated in EHR use and whether they can be changed or improved.

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Learning to use electronic health records: can we stay patient-centered? A pre-post intervention study with family medicine residents

Cited by 12 publications

References 52 publications

Impact of an Educational Comic to Enhance Patient-Physician–Electronic Health Record Engagement: Prospective Observational Study

Impact of an Educational Comic to Enhance Patient-Physician–Electronic Health Record Engagement: Prospective Observational Study

How Do Patients Want Us to Use the Computer During Medical Encounters?—A Discrete Choice Experiment Study

What factors influence the use of electronic health records during the first 10 minutes of the clinical encounter?

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