Patient-centered Electronic Health Record Research Articles

Training to improve patient-centered electronic health record (EHR) use

Training to improve patient-centered electronic health record (EHR) use

Connecting the Dots: Evaluating the Impact of Graphic Medicine to Empower Patient-Centered Technology Use

Purpose, Electronic health record (EHR) use impacts patient-centered communication. Therefore, how providers use EHR during clinical interactions is key. Unfortunately, providers receive little training specific to EHR-related behaviors, and no studies have assessed how advocacy interventions can increase patient EHR engagement. Given that graphic medicine has been effective in health education, our study aims to evaluate the impact of graphic medicine comics in promoting patient-centered EHR use and patient engagement during outpatient visits. Methods, Patient and provider comics, based on published systematic reviews and a qualitative patient perception study, each highlighted three patient-centered EHR use …

Integrating Patient-Centered Electronic Health Record Communication Training into Resident Onboarding: Curriculum Development and Post-Implementation Survey Among Housestaff.

BackgroundElectronic health record (EHR) use can enhance or undermine the ability of providers to deliver effective, humanistic patient-centered care. Given patient-centered care has been found to positively impact patient health outcomes, it is critical to provide formal education on patient-centered EHR communication skills. Unfortunately, despite increasing worldwide EHR adoption, few institutions educate trainees on EHR communication best practices.ObjectiveThe goal of this research was to develop and deliver mandatory patient-centered EHR training to all incoming housestaff at the University of Chicago.MethodsWe developed a brief patient-centered EHR use curriculum highlighting best practices based on a literature search. Training was embedded into required EHR onboarding for all incoming housestaff (interns, residents, and fellows) at the University of Chicago in 2015 and was delivered by institutional Clinical Applications Trainers. An 11-item posttraining survey consisting of ten 5-point Likert scale questions and 1 open-ended question was administered. Responses at the high end of the scale were grouped to dichotomize data.ResultsAll 158 of the incoming 2015 postgraduate trainees participated in training and completed surveys (158/158, 100.0%). Just over half (86/158, 54.4%) were interns and the remaining were residents and fellows (72/158, 45.6%). One-fifth of respondents (32/158, 20.2%) were primary care trainees (defined as internal medicine, pediatric, and medicine-pediatric trainees), and the remaining 79.7% (126/158) were surgical or specialty trainees. Self-perceived pre- versus posttraining knowledge of barriers, best practices, and ability to implement patient-centered EHR skills significantly increased (3.1 vs 3.9, P<.001 for all). Most felt training was effective (90.5%), should be required (86.7%), and would change future practice as a result (70.9%). The only significant difference between intern and resident/fellow responses was prior knowledge of patient-centered EHR use barriers; interns endorsed higher prior knowledge than resident peers (3.27 vs 2.94 respectively, P=.03). Response comparison of specialty or surgical trainees (n=126) to primary care trainees (n=32) showed no significant differences in prior knowledge of barriers (3.09 vs 3.22, P=.50), of best practices (3.08 vs 2.94, P=.37), or prior ability to implement best practices (3.11 vs 2.84, P=.15). Primary care trainees had larger increases posttraining than surgical/specialty peers in knowledge of barriers (0.8 vs 0.7, P=.62), best practices (1.1 vs 0.8, P=.08), and ability to implement best practices (1.1 vs 0.7, P=.07), although none reached statistical significance. Primary care trainees also rated training as more effective (4.34 vs 4.09, P=.03) and felt training should be required (4.34 vs 4.09, P=.10) and would change their future practice as a result (4.13 vs 3.73, P=.02).ConclusionsEmbedding EHR communication skills training into required institutional EHR training is a novel and effective way to teach key EHR skills to trainees. Such training may help ground trainees in best practices and contribute to cultivating an institutional culture of humanistic, patient-centered EHR use.

Incorporating the human touch: piloting a curriculum for patient-centered electronic health record use

ABSTRACTBackground: Integrating electronic health records (EHRs) into clinical care can prevent physicians from focusing on patients. Despite rapid EHR adoption, few curricula teach communication skills and best practices for patient-centered EHR use.Objective: We piloted a ‘Patient-centered EHR use’ curriculum, consisting of a lecture and group-observed structured clinical examination (GOSCE) for second-year students (MS2s).Design: During the lecture, students watched a trigger tape video, engaged in a reflective observation exercise, and learned best practices. During the GOSCE, one of four MS2s interacted with a standardized patient (SP) while using the EHR. Third-year students (MS3s) received no formal training and served as a historical control group by completing the same OSCE individually. All students completed post-GOSCE/OSCE surveys. The SP evaluated GOSCE/OSCE performance.Results: In 2013, 89 MS2s participated in the workshop and GOSCEs during their required Clinical Skills course and 96 MS3s participated in individual OSCEs during their end of year multi-station formative GOSCE exercise. Eighty MS2s (90%) and 88 MS3s (92%) post-GOSCE/OSCE surveys were analyzed. Compared to MS3s, significantly more MS2s rated their knowledge (19% vs 55%) and training (14% vs 39%) as good (≥4/5 point scale, P < .001 for both). Most learners (85% MS2s and 70% MS3s) thought training should be required for all students. SP ratings on GOSCE/OSCE performance was higher for the 20 MS2s compared to the 88 MS3 controls (73.5 [SD = 4.5] vs 58.1 [SD = 13.1] on 80 point scale, P < .001).Conclusions: A short workshop and GOSCE were effective in teaching patient-centered EHR use. This curriculum is now a permanent part of our Clinical Skills course. Clerkship students who did not receive our curriculum may have been exposed to negative role-modeling on the wards. To address this, training residents and faculty on patient-centered EHR use skills should be considered.Abbreviations: EHR: Electronic health record; EHR: Electronic health record; SP: Standardized patient

A hybrid solution for extracting structured medical information from unstructured data in medical records via a double-reading/entry system.

BackgroundHealthcare providers generate a huge amount of biomedical data stored in either legacy system (paper-based) format or electronic medical records (EMR) around the world, which are collectively referred to as big biomedical data (BBD). To realize the promise of BBD for clinical use and research, it is an essential step to extract key data elements from unstructured medical records into patient-centered electronic health records with computable data elements. Our objective is to introduce a novel solution, known as a double-reading/entry system (DRESS), for extracting clinical data from unstructured medical records (MR) and creating a semi-structured electronic health record database, as well as to demonstrate its reproducibility empirically.MethodsUtilizing the modern cloud-based technologies, we have developed a comprehensive system that includes multiple subsystems, from capturing MRs in clinics, to securely transferring MRs, storing and managing cloud-based MRs, to facilitating both machine learning and manual reading, and to performing iterative quality control before committing the semi-structured data into the desired database. To evaluate the reproducibility of extracted medical data elements by DRESS, we conduct a blinded reproducibility study, with 100 MRs from patients who have undergone surgical treatment of lung cancer in China. The study uses Kappa statistic to measure concordance of discrete variables, and uses correlation coefficient to measure reproducibility of continuous variables.ResultsUsing the DRESS, we have demonstrated the feasibility of extracting clinical data from unstructured MRs to create semi-structured and patient-centered electronic health record database. The reproducibility study with 100 patient’s MRs has shown an overall high reproducibility of 98 %, and varies across six modules (pathology, Radio/chemo therapy, clinical examination, surgery information, medical image and general patient information).ConclusionsDRESS uses a double-reading, double-entry, and an independent adjudication, to manually curate structured data elements from unstructured clinical data. Further, through distributed computing strategies, DRESS protects data privacy by dividing MR data into de-identified modules. Finally, through internet-based computing cloud, DRESS enables many data specialists to work in a virtual environment to achieve the necessary scale of processing thousands MRs within days. This hybrid system represents probably a workable solution to solve the big medical data challenge.Electronic supplementary materialThe online version of this article (doi:10.1186/s12911-016-0357-5) contains supplementary material, which is available to authorized users.

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

ObjectivesTo 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. MethodsWe 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. ResultsWe 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. ConclusionPatients 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.

Keeping our Eye on The Ball: Managing The Evolution of Electronic Health Records

The AAFP’s leadership regarding Electronic Health Records (EHRs) has been impressive. As the Future of Family Medicine report underscored, EHRs include not only clinical information systems but also scheduling, billing and other functionalities, and these broader functionalities are critical for the fiscal viability of the New Model of Family Medicine. The AAFP initiative has created a market in small-office EHRs, resulting in development of common technical standards and better understanding of the costs of EHR adoption, greatly speeding the process. The Academy’s leadership has also led other professional organizations and the federal government to address the fundamental structure of health records, including the Continuity of Care Record (CCR), pay-for-performance measures, and EHR certification. ADFM believes, however, that these successes represent only a first step. As important as small-office EHRs are, they represent a by-station on the road towards the information systems we will need for primary care. If we allow the small-office EHR to represent the sole vision of family medicine, then family medicine will be forever confined to an office, largely unconnected to the other settings in which our patients receive care. We believe that family medicine must keep its eye on the goal—a patient-centered electronic health record which will allow the family physician to manage care across the spectrum of care, combining office with hospital, insurer and public health data to allow continuous improvement of access, costs and outcomes. To achieve this vision, we will need to confront substantial organizational, financial and intellectual challenges. These include: Interconnectivity. Many hospital systems have developed hybrid systems that are partly homegrown and partly commercial. Given the complexity of the tasks, limited number of vendors and huge investments, health systems are often conservative. Interconnectivity with outpatient EHRs often seems a low priority for hospital based systems; yet, in order to create the information system primary care needs, we must bridge this gap. The evolving certification process will help. Financing. In small offices, EHRs offer hope of improving cash flow through pay-for-performance and reduction of dictation and staffing costs. However, as a recent ADFM survey has shown, most family medicine units incur the costs of implementation without the benefits of the associated savings. Ease of Data Entry. Structured data entry facilitates chronic disease management. Direct entry by clinicians, however, is often cumbersome, making transition to EHRs challenging and often lowering productivity. Resolving this is a priority. Some EHRs work better than others, of course, and the ultimate solution may be technical—voice recognition technology that also enables coding and disease management prompts. Patient-entered data through personal health records and interfaces to immunization, laboratory, or radiology databases will also help. Underdeveloped Office Systems. Realizing the full potential of EHRs requires office system reengineering and customizations in software. Yet EHR conversion can prove so exhausting that clinical system redesign is not done immediately. Specifics will vary with site and EHR. Addressing Comorbidity. Family physicians bring to health care the potential to manage multiple chronic diseases simultaneously. Yet, the architecture of most available EHRs allow disease management 1 disease template at a time. A priority for family medicine must be facilitating management of multiple diseases at a single visit. RHIOs (Regional Health Information Organizations). The full potential of EHRs will be realized only when a patient’s health information becomes accessible to her family physician regardless of geography or insurer. Compatibility among systems will be slow to progress, competitive systems will be reluctant to share information, and regulation will complicate the process. Individually, each of these areas represents a substantial organizational, intellectual and financial challenge. Together, the list is daunting. As with any journey, however, the first steps are the most important—and we need to start by understanding what is important. Departments of family medicine have a major role to play. The market has produced large systems like Epic and others that are increasingly capable of addressing both the needs of complex medical centers and small office practices. Users’ groups for each of these systems and direct linkages with developers can drive system development. Departments also have many faculty who play leadership roles in their institutions’ informatics groups, as well as connections to broader Academic Health Center and University IS resources. How can we as a discipline organize this strategic resource? Finally, increasing numbers of family medicine researchers have substantial expertise in disease/population management or the management of particular clinical problems. How can the discipline leverage their expertise to manage the evolution of electronic health records?