Jing Zhang1, Yunan Chen2, Shazia Ashfaq3, Kristin Bell4, Alan Calvitti3, Neil J Farber5, Mark T Gabuzda4, Barbara Gray3, Lin Liu6, Steven Rick3, Richard L Street7, Kai Zheng8, Danielle Zuest3, Zia Agha9. 1. Department of Biomedical Informatics, University of California, San Diego, San Diego, CA, USA Health Services Research & Development, VA San Diego Healthcare System, San Diego, CA, USA. 2. Health Services Research & Development, VA San Diego Healthcare System, San Diego, CA, USA Department of Informatics, University of California, Irvine, Irvine, CA, USA yunanc@ics.uci.edu. 3. Health Services Research & Development, VA San Diego Healthcare System, San Diego, CA, USA. 4. Department of Internal Medicine, VA San Diego Health Care System, San Diego, CA, USA Department of Medicine, University of California, San Diego, San Diego, CA, USA. 5. Department of Medicine, University of California, San Diego, San Diego, CA, USA. 6. Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA, USA. 7. Department of Communication, Texas A&M University, College Station, TX, USA. 8. School of Public Health Department of Health Management and Policy, School of Information, University of Michigan, Ann Arbor, MI, USA. 9. Health Services Research & Development, VA San Diego Healthcare System, San Diego, CA, USA Department of Medicine, University of California, San Diego, San Diego, CA, USA West Health Institute, La Jolla, CA, USA.
Abstract
OBJECTIVE: Electronic health records (EHRs) have great potential to improve quality of care. However, their use may diminish "patient-centeredness" in exam rooms by distracting the healthcare provider from focusing on direct patient interaction. The authors conducted a qualitative interview study to understand the magnitude of this issue, and the strategies that primary care providers devised to mitigate the unintended adverse effect associated with EHR use. METHODS AND MATERIALS: Semi-structured interviews were conducted with 21 healthcare providers at 4 Veterans Affairs (VAs) outpatient primary care clinics in San Diego County. Data analysis was performed using the grounded theory approach. RESULTS: The results show that providers face demands from both patients and the EHR system. To cope with these demands, and to provide patient-centered care, providers attempt to perform EHR work outside of patient encounters and create templates to streamline documentation work. Providers also attempt to use the EHR to engage patients, establish patient buy-in for EHR use, and multitask between communicating with patients and using the EHR. DISCUSSION AND CONCLUSION: This study has uncovered the challenges that primary care providers face in integrating the EHR into their work practice, and the strategies they use to overcome these challenges in order to maintain patient-centered care. These findings illuminate the importance of developing "best" practices to improve patient-centered care in today's highly "wired" health environment. These findings also show that more user-centered EHR design is needed to improve system usability.
OBJECTIVE: Electronic health records (EHRs) have great potential to improve quality of care. However, their use may diminish "patient-centeredness" in exam rooms by distracting the healthcare provider from focusing on direct patient interaction. The authors conducted a qualitative interview study to understand the magnitude of this issue, and the strategies that primary care providers devised to mitigate the unintended adverse effect associated with EHR use. METHODS AND MATERIALS: Semi-structured interviews were conducted with 21 healthcare providers at 4 Veterans Affairs (VAs) outpatient primary care clinics in San Diego County. Data analysis was performed using the grounded theory approach. RESULTS: The results show that providers face demands from both patients and the EHR system. To cope with these demands, and to provide patient-centered care, providers attempt to perform EHR work outside of patient encounters and create templates to streamline documentation work. Providers also attempt to use the EHR to engage patients, establish patient buy-in for EHR use, and multitask between communicating with patients and using the EHR. DISCUSSION AND CONCLUSION: This study has uncovered the challenges that primary care providers face in integrating the EHR into their work practice, and the strategies they use to overcome these challenges in order to maintain patient-centered care. These findings illuminate the importance of developing "best" practices to improve patient-centered care in today's highly "wired" health environment. These findings also show that more user-centered EHR design is needed to improve system usability.
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