scholarly journals The electronic health record as a patient engagement tool: mirroring clinicians’ screen to create a shared mental model

JAMIA Open ◽  
2018 ◽  
Vol 1 (1) ◽  
pp. 42-48 ◽  
Author(s):  
Onur Asan ◽  
Jeanne Tyszka ◽  
Bradley Crotty
Keyword(s):  
Patient Engagement ◽  
General Medicine ◽  
Clinic Visit ◽  
Care Process ◽  
Health Records ◽  
Exam Room ◽  
Quantitative Results ◽  
General Medicine Clinic ◽  
Electronic Health ◽  
Screen Sharing

Abstract Objective Electronic health records (EHRs) in physician offices can both enhance and detract from the patient experience. Best practices have emerged focusing on screen sharing. We sought to determine if adding a second monitor, mirroring the EHR for patients, would be welcome and useful for patients and clinicians. Materials and Methods This mixed-method study was conducted in a general medicine clinic from March to June 2016. Clinicians and patients met in a specially equipped exam room with a patient-facing monitor. Visits were video-recorded to assess time spent viewing the EHR and followed by interviews, which were transcribed and analyzed using established qualitative methods. Results Eight clinicians and 24 patients participated. Main themes included the second screen serving as a catalyst for patient engagement, augmenting the clinic visit in a meaningful way, improving transparency of the care process and documentation, and providing a substantially different experience for patients than a shared single screen. Concerns and suggestions for improvement were also reported. Quantitative results showed high patient engagement times with the EHR (25% of the visit length) compared to reports in previous studies. The median satisfaction score was 5 out of 5 for patients and 3.3 out of 5 for clinicians. Discussion and Conclusion Providing patient access to the EHRs with this design was linked with several benefits including improved patient engagement, education, transparency, comprehension, and trust. Future studies should explore how best to display information in such screens for patients and identify impact on care, safety, and quality.

Increase in the patient wait-time and delays in the clinic workflow post-implementation of the electronic health record.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 194-194
Author(s):  
Meyyammai Narayanan ◽  
Xiao Zhou ◽  
Shawn J Janarthanan ◽  
Mary Daniel ◽  
Maria Olmedo ◽  
...  
Keyword(s):  
Wait Time ◽  
Total Sample ◽  
Health Records ◽  
Exam Room ◽  
Patient Wait Time ◽  
Electronic Health ◽  
The Impact ◽  
Implementation Of Ehr ◽  
New System

194 Background: Growth in patient (pt) volume and limited clinic capacity can lead to long wait-times and pt/provider dissatisfaction. We have previously shown that the room pooling model, can reduce pt wait-time in the exam room, improve room utilization, and pt/providers satisfaction (ASCO 2016, Abstract 6595). One of the important goals of adopting electronic health records (EHR) is also to increase the clinical efficiencies, productivity and quality of care. The purpose of this study was to evaluate the impact of implementation of EHR on pt wait-time in the exam room and satisfaction in the Sarcoma Center. Methods: The time studies and pt and provider wait-time satisfaction surveys were carried out over 2 weeks prior to (baseline) and 6 months after the implementation of EHR. All times of when pts, mid-level providers, and doctors (MD) entered and exited the exam rooms were collected for a total sample size of 578 pts (300 before, 278 after) seen during the clinic hours and analyzed using JMP and SAS. Results: The proportion of pts seen within 30 minutes (Min) by MDs from the time pts roomed into exam room decreased by about 32% [from 53% (148/280) to 36% (94/259), p = 0.0001] post implementation of EHR. The median time for pts in the exam room waiting for MD increased (p = 0.0001) from 30 min (range: 0-126 min) to 40 min (range: 0-121 min). Although, the pt satisfaction did not significantly change [increase from 8% (23/278) to 12% (31/267) in the number of pts that were not satisfied to little-satisfied, and decrease from 92% (255/278) to 88% (236/267) in pts that were moderately to very-satisfied], the number of times MD had to wait for an open exam room increased from 8% (5/65) to 24% (14/59, p = 0.01). The delays to see MDs were associated with longer time spent with the nurse (from median 4 to 7 min), followed by delays in seeing Mid-level provider (from 11 to 18 min). Conclusions: These findings indicate that in the initial stages of implementation of EHR, the increase in pt wait-time and reduced clinical efficiencies can be related to the learning of and adapting to the new system. Attempts targeted to the areas of delays (such as training and redesigning workflow) may reduce the pt wait-time and improve the clinical efficiency.

A Case Study to Assess Implementation of Electronic Health Records at Central Flacq Hospital, Mauritius

2012 ◽  
Vol 3 (1) ◽  
pp. 1-13
Author(s):  
Mohit Arora ◽  
Ashish Joshi
Keyword(s):  
Electronic Health Records ◽  
Quantitative Methods ◽  
Middle Level ◽  
Health Records ◽  
Qualitative And Quantitative Methods ◽  
Long Time ◽  
Quantitative Results ◽  
Electronic Health ◽  
Mixed Approach

The challenges of implementing electronic health records (EHRs) have received some attention, but little is known about the process of transitioning from paper-based to electronic files. In this paper, a mixed approach using combined qualitative and quantitative methods is utilized. The authors enrolled nine administrative managers and 87 employees from different backgrounds, all part of a regional hospital at Flacq in Mauritius, from April to May 2011. Employees responded to a survey on various aspects pertaining to their eagerness to accept the shift to electronic health records and their views on the probability of success. Descriptive and inferential statistics were used to analyze the quantitative results and content analysis was performed on the qualitative data. Nurses performing at middle level agreed that a shift to EHR is positive but felt that it might take a long time to effect the change. With its implementation, they agreed that advantages like up to date information, diminished workload, and cost effectiveness would be easily attained. In contrast, focus groups confirmed that without the collaboration and support of management, implementation of EHR would prove arduous.

Implementation of personal health records by case managers in a VAMC general medicine clinic

2004 ◽  
Vol 54 (1) ◽  
pp. 27-33 ◽  
Author(s):  
Joanne K Tobacman ◽  
Pamella Kissinger ◽  
Marilyn Wells ◽  
Joan Prokuski ◽  
Mary Hoyer ◽  
...  
Keyword(s):  
General Medicine ◽  
Case Managers ◽  
Personal Health Records ◽  
Personal Health ◽  
Health Records ◽  
Medicine Clinic ◽  
General Medicine Clinic

scholarly journals Improving Patient–Provider Communication and Therapeutic Practice Through Better Integration of Electronic Health Records in the Exam Room: A Pilot Study

2018 ◽  
Vol 46 (3) ◽  
pp. 484-493 ◽  
Author(s):  
Minal R. Patel ◽  
Alyssa Smith ◽  
Harvey Leo ◽  
Wei Hao ◽  
Kai Zheng
Keyword(s):  
Electronic Health Records ◽  
Communication Skills ◽  
Provider Communication ◽  
Patient Centered ◽  
Health Records ◽  
Exam Room ◽  
Communication Practices ◽  
Asthma Outcomes ◽  
Electronic Health

Background. The rapid proliferation of electronic health records (EHRs) in clinics has had mixed impact on patient-centered communication, yet few evaluated interventions exist to train practicing providers in communication practices. Aims. We extended the evidence-based Physician Asthma Care Education (PACE) program with EHR-specific communication strategies, and tested whether training providers with the extended program (EHR-PACE) would improve provider and patient perceptions of provider communication skills and asthma outcomes of patients. Method. A pilot randomized design was used to compare EHR-PACE with usual care. Participants were providers ( n = 18) and their adult patients with persistent asthma ( n = 126). Outcomes were assessed at baseline and 3- and 6-month postintervention, including patient perception of their provider’s communication skills and provider confidence in using EHRs during clinical encounters. Results. Compared with the control group, providers who completed the EHR-PACE program reported significant improvements at 3-month follow-up in their confidence with asthma counseling practices (estimate 0.90, standard error [ SE] 0.4); p < .05) and EHR-specific communication practices (estimate 2.3, SE 0.8; p < .01), and at 6-month follow-up, a significant decrease in perception that the computer interferes with the patient–provider relationship (estimate −1.0, SE 0.3; p < .01). No significant changes were observed in patient asthma outcomes or their perception of their provider’s communication skills. Discussion. Training providers with skills to accommodate EHR use in the exam room increases provider confidence and their perceived skills in maintaining patient-centered communications in the short term. Conclusion. Evidence-supported training initiatives that can increase capacity of busy providers to manage increased computing demands shows promise. More research is needed to fully evaluate EHR-PACE on patients’ health status and their perceptions of their provider’s care through a large-scale trial.

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