Strategizing EHR use to achieve patient-centered care in exam rooms: a qualitative study on primary care providers

Zhang, Jing; Chen, Yunan; Ashfaq, Shazia; Bell, Kristin; Calvitti, Alan; Farber, Neil J.; Gabuzda, Mark T.; Gray, Barbara; Liu, Lin; Rick, Steven; Street, Richard L.; Zheng, Kai; Zuest, Danielle; Agha, Zia

doi:10.1093/jamia/ocv142

Cited by 38 publications

(50 citation statements)

References 25 publications

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“…27 Interestingly, only 5% of patients seen by faculty reported feeling this way. 27 Recently, papers suggesting strategies for combatting these negative effects have published, 22,10 but they are usually based on physician ideas of how to accomplish patient-centeredness. We have introduced the patient's voice into that discussion.…”

Section: Discussionmentioning

confidence: 99%

“…Physicians also believe that screen-sharing can be beneficial. 22 One study videotaped primary care visits, and demonstrated that almost half of the visits included the physician actively sharing the computer screen with patients. 30 In our study, patients reported that screen sharing resulted in increased trust in their doctors, and that not sharing the screen made some suspicious.…”

Section: Discussionmentioning

confidence: 99%

“…Similar qualitative studies using semi-structured interviews reached saturation with 15-20 interviews. 22, 23 …”

Section: Methodsmentioning

confidence: 99%

“…21 Recent studies have increasingly focused on how EHR should be used and designed in more patient-centered ways. 22 Some of the studies have reported that EHR should be used as a communication and patient education tool (i.e. through screen sharing).…”

Section: Introductionmentioning

confidence: 99%

“…Several studies reported physicians perceptions' of patient centered EHR use 22,24 , and some other opinion papers showed the importance of screen sharing for patient centered-EHR use. 7 However, we also need more comprehensive input from the patient for the current EHRs including its impact on patient engagement, their perception of providers' EHR use, as well as their perception on patient centered EHR use during the visit.…”

Section: Introductionmentioning

confidence: 99%

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Capturing the patients’ voices: Planning for patient-centered electronic health record use

Asan

Tyszka

Fletcher

2016

International Journal of Medical Informatics

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Objectives To understand 1) the perceptions of patients regarding use of EHR during clinic visits, 2) the impact of the presence of EHR on patient interactions with physicians, and 3) the ways in which EHR usage might increase patient engagement. Methods We conducted semi-structured interviews of a convenience sample of patients of internal medicine resident doctors from three primary care clinics. Interviews were audio-recorded and transcribed verbatim. We used thematic analysis to identify themes from the transcripts. Informed consent was obtained from each participant. Results We interviewed 32 patients; 37.5% male. Our analysis revealed three primary themes: (1) the views and beliefs of patients on the use of EHR in clinics, (2) patients' perception of the communication skills of residents, and (3) patients' perceptions about information sharing, patient engagement, and health education related to the EHR. An invitation to patients to view the screen as the physician interprets its content increases patient satisfaction and understanding. Residents' possessed skills in communication is not impeded when using EHR. Conclusion Patients generally express a positive or neutral perception of EHR use during clinic visits. Using information voiced by patients, we can teach health providers EHR strategies that are likely to engage patients in the visit and engender their trust.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Similar qualitative studies using semi-structured interviews reached saturation with 15-20 interviews. 22, 23 …”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Capturing the patients’ voices: Planning for patient-centered electronic health record use

Asan

Tyszka

Fletcher

2016

International Journal of Medical Informatics

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Time Requirements for Electronic Health Record Use in an Academic Ophthalmology Center

et al. 2017

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IMPORTANCE Electronic health record (EHR) systems have transformed the practice of medicine. However, physicians have raised concerns that EHR time requirements have negatively affected their productivity. Meanwhile, evolving approaches toward physician reimbursement will require additional documentation to measure quality and cost of care. To date, little quantitative analysis has rigorously studied these topics.OBJECTIVE To examine ophthalmologist time requirements for EHR use. DESIGN, SETTING, AND PARTICIPANTSA single-center cohort study was conducted between September 1, 2013, and December 31, 2016, among 27 stable departmental ophthalmologists (defined as attending ophthalmologists who worked at the study institution for Ն6 months before and after the study period). Ophthalmologists who did not have a standard clinical practice or who did not use the EHR were excluded.EXPOSURES Time stamps from the medical record and EHR audit log were analyzed to measure the length of time required by ophthalmologists for EHR use. Ophthalmologists underwent manual time-motion observation to measure the length of time spent directly with patients on the following 3 activities: EHR use, conversation, and examination. MAIN OUTCOMES AND MEASURESThe study outcomes were time spent by ophthalmologists directly with patients on EHR use, conversation, and examination as well as total time required by ophthalmologists for EHR use. RESULTSAmong the 27 ophthalmologists in this study (10 women and 17 men; mean [SD] age, 47.3 [10.7] years [median, 44; range, 34-73 years]) the mean (SD) total ophthalmologist examination time was 11.2 (6.3) minutes per patient, of which 3.0 (1.8) minutes (27% of the examination time) were spent on EHR use, 4.7 (4.2) minutes (42%) on conversation, and 3.5 (2.3) minutes (31%) on examination. Mean (SD) total ophthalmologist time spent using the EHR was 10.8 (5.0) minutes per encounter (range, 5.8-28.6 minutes). The typical ophthalmologist spent 3.7 hours using the EHR for a full day of clinic: 2.1 hours during examinations and 1.6 hours outside the clinic session. Linear mixed effects models showed a positive association between EHR use and billing level and a negative association between EHR use per encounter and clinic volume. Each additional encounter per clinic was associated with a decrease of 1.7 minutes (95% CI, -4.3 to 1.0) of EHR use time per encounter for ophthalmologists with high mean billing levels (adjusted R 2 = 0.42; P = .01). CONCLUSIONS AND RELEVANCEOphthalmologists have limited time with patients during office visits, and EHR use requires a substantial portion of that time. There is variability in EHR use patterns among ophthalmologists.

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Communication Skills to Engage Patients in Treatment

Ruben¹,

Blanch‐Hartigan²,

Hall³

2020

The Wiley Handbook of Healthcare Treatment Engagement

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Strategizing EHR use to achieve patient-centered care in exam rooms: a qualitative study on primary care providers

Cited by 38 publications

References 25 publications

Capturing the patients’ voices: Planning for patient-centered electronic health record use

Capturing the patients’ voices: Planning for patient-centered electronic health record use

Time Requirements for Electronic Health Record Use in an Academic Ophthalmology Center

Communication Skills to Engage Patients in Treatment

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