Abstract
BackgroundEmbedding patient accommodation need in the electronic health record (EHR) has been proposed as one means to improve health care delivery to patients with disabilities. Accommodation need is not a standard field in commercial EHR software. However, some medical practices ask about accommodation need and store it in the EHR. Little is known about how the information is used, or barriers to its use. This exploratory-descriptive study examines whether and how information about patients’ disability-related accommodation needs stored in patient records is used in a primary health care center to plan for care.MethodsFour focus groups (n = 35) were conducted with staff of a Federally Qualified Health Center that asks four accommodation questions at intake for the EHR. Respondents were asked how they learned about patient accommodation need, whether and how they used the information in the EHR, barriers to its use, and recommendations for where accommodation information should reside. A brief semi-structured interview was conducted with patients who had indicated an accommodation need (n = 12) to learn their experience at their most recent appointment. The qualitative data were coded using structural coding and themes extracted.ResultsFive themes were identified from the focus groups: (1) staff often do not know accommodation needs before the patient’s arrival; (2) electronic patient information systems offer helpful information, but their structure creates challenges and information gaps; (3) accommodations for a patient’s disability occur, but are developed at the time of visit; (4) provider knowledge of a regular patient is often the basis for accommodation preparation; and (5) staff recognize benefits to advance knowledge of accommodation needs and are supportive of methods to enable it. Most patients did not recall indicating accommodation need on the intake form. However, they expected to be accommodated based upon the medical practice’s knowledge of them.ConclusionsPatient accommodation information in the EHR can be useful for visit planning. However, the structure must enable transfer of information between scheduling and direct care and be updatable as needs change. Flexibility to record a variety of needs, visibility to differentiate accommodation need from other alerts, and staff education about needs were recommended.
Highlights
Embedding patient accommodation need in the electronic health record (EHR) has been proposed as one means to improve health care delivery to patients with disabilities
As part of exploring the collection and use of accommodation need information, a fourth focus sought to know (4) if patients had expectations of disability-related accommodations because they indicated a need on the registration form. Study design This exploratory-descriptive study is grounded in the framework of the Normalization Process model, an implementation model for factors affecting the routinization of new practices, actions, or ways of organizing work in healthcare settings [29]
Groups were a mix of staff that included a doctor, nurses, medical assistants, social workers, referral specialists, psychologists, triage assistants, managers, administrative assistants, and receptionists
Summary
Embedding patient accommodation need in the electronic health record (EHR) has been proposed as one means to improve health care delivery to patients with disabilities. Little is known about how the information is used, or barriers to its use This exploratory-descriptive study examines whether and how information about patients’ disability-related accommodation needs stored in patient records is used in a primary health care center to plan for care. The problems include physically inaccessible medical buildings and physician offices, lack of accessible medical and diagnostic equipment, and inadequate procedures providers follow to ensure effective delivery of care [4,5,6,7,8]. Where these types of barriers are present, patients will require modifications, called reasonable accommodations, in order to receive care. A patient may receive inferior care (for example, examined in a chair rather than on a table) or must make additional trips to the provider for the care that most people receive with a single visit
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