Feasibility and Implementation of Patient Engagement Tools in Electronic Health Records to Enhance Patient-Centered Communication: A Protocol (Preprint)

BACKGROUND Patient-physician communication during clinical encounters is essential to quality of care. Numerous efforts have been attempted to improve patient-physician communication. Incorporating patient priorities into agenda setting and medical decision making are fundamental to patient-centered communication. Efficient and scalable approaches are needed to empower patients to speak up and to prepare physicians to respond. Leveraging electronic health records (EHR) in engaging patients and the healthcare team has the potential to enhance the integration of patient priorities in clinical encounters. A systematic approach to eliciting and documenting patient priorities before encounters could facilitate effective communication in encounters. OBJECTIVE The objective of our paper is to report the design and implementation of a set of EHR tools built into clinical workflow that facilitates patient-physician joint agenda setting and the documentation of patient concerns in the EHR for ambulatory encounters. METHODS We engaged health information technology leaders and users in three healthcare systems in developing and implementing a set of EHR tools. The goal of these tools is to standardize the eliciting of patient priorities using a pre-visit patient important issues questionnaire distributed through the patient portal to the EHR. We built additional EHR documentation tools to facilitate patient-staff communication during rooming and a simple transmission method for physicians to incorporate patient concerns in EHR notes. RESULTS A total of 34,037 primary care patients from three health systems (26,441, 5,136, and 2,460 separately from each system) used the patient important issues pre-visit questionnaire in 2020. The adoption of the digital pre-visit questionnaire during COVID period was much higher in one healthcare system because it expanded the use of the questionnaire from trial participating physicians to all primary care providers midway through the year. It also required the use of the pre-visit patient important issue questionnaire for e-check-ins which is required for telehealth encounters. Physicians and staff suggested anecdotally that this questionnaire helped patient-clinician communication, particularly during the COVID pandemic. CONCLUSIONS EHR tools have the potential to facilitate the integration of patient priorities into agenda setting and documentation in real world primary care practices. Early results suggest feasibility and acceptability of such digital tools in three health systems. EHR tools can support patient engagement and clinician’s work in both in-person and telehealth visits. They could potentially exert a sustained influence on patient and clinician communication behaviors in contrast to prior ad hoc educational efforts targeting patients or clinicians. CLINICALTRIAL ClinicalTrials.gov NCT03385512; https://clinicaltrials.gov/ct2/show/NCT03385512