Jorie M Butler1,2,3, Bryan Gibson4, Lacey Lewis2, Gayle Reiber2, Heidi Kramer4, Rand Rupper1,3, Jennifer Herout5, Brenna Long5, David Massaro5, Jonathan Nebeker1,3,5. 1. Geriatric Research and Clinical Center (GRECC), George E. Wahlen Veteran Affairs Medical Center, Salt Lake City, Utah, USA. 2. Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah, USA. 3. Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA. 4. Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA. 5. Department of Veterans Affairs Office of Health Informatics, Washington, District of Columbia, USA.
Abstract
OBJECTIVE: Healthcare systems have adopted electronic health records (EHRs) to support clinical care. Providing patient-centered care (PCC) is a goal of many healthcare systems. In this study, we sought to explore how existing EHR systems support PCC; defined as understanding the patient as a whole person, building relational connections between the clinician and patient, and supporting patients in health self-management. MATERIALS AND METHODS: We assessed availability of EHR functions consistent with providing PCC including patient goals and preferences, integrated care plans, and contextual and patient-generated data. We surveyed and then interviewed technical representatives and expert clinical users of 6 leading EHR systems. Questions focused on the availability of specific data and functions related to PCC (for technical representatives) and the clinical usefulness of PCC functions (for clinicians) in their EHR. RESULTS: Technical representatives (n = 6) reported that patient communication preferences, personalized indications for medications, and end of life preferences were functions implemented across 6 systems. Clinician users (n = 10) reported moderate usefulness of PCC functions (medians of 2-4 on a 5-pointy -35t scale), suggesting the potential for improvement across systems. Interviews revealed that clinicians do not have a shared conception of PCC. In many cases, data needed to deliver PCC was available in the EHR only in unstructured form. Data systems and functionality to support PCC are under development in these EHRs. DISCUSSION AND CONCLUSION: There are current gaps in PCC functionality in EHRs and opportunities to support the practice of PCC through EHR redesign. Published by Oxford University Press on behalf of the American Medical Informatics Association 2020. This work is written by a US Government employee and is in the public domain in the US.
OBJECTIVE: Healthcare systems have adopted electronic health records (EHRs) to support clinical care. Providing patient-centered care (PCC) is a goal of many healthcare systems. In this study, we sought to explore how existing EHR systems support PCC; defined as understanding the patient as a whole person, building relational connections between the clinician and patient, and supporting patients in health self-management. MATERIALS AND METHODS: We assessed availability of EHR functions consistent with providing PCC including patient goals and preferences, integrated care plans, and contextual and patient-generated data. We surveyed and then interviewed technical representatives and expert clinical users of 6 leading EHR systems. Questions focused on the availability of specific data and functions related to PCC (for technical representatives) and the clinical usefulness of PCC functions (for clinicians) in their EHR. RESULTS: Technical representatives (n = 6) reported that patient communication preferences, personalized indications for medications, and end of life preferences were functions implemented across 6 systems. Clinician users (n = 10) reported moderate usefulness of PCC functions (medians of 2-4 on a 5-pointy -35t scale), suggesting the potential for improvement across systems. Interviews revealed that clinicians do not have a shared conception of PCC. In many cases, data needed to deliver PCC was available in the EHR only in unstructured form. Data systems and functionality to support PCC are under development in these EHRs. DISCUSSION AND CONCLUSION: There are current gaps in PCC functionality in EHRs and opportunities to support the practice of PCC through EHR redesign. Published by Oxford University Press on behalf of the American Medical Informatics Association 2020. This work is written by a US Government employee and is in the public domain in the US.
Entities:
Keywords:
electronic health records; patient-centered care; patient-generated data
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