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Patient EHR Note Input Boosts Patient-Provider Communication

Three-quarters of patients and providers said patient EHR note collaboration improved patient-provider communication.

Patient EHR note input drives positive patient-provider communication.

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- Allowing patients to collaborate on EHR notes to set appointment agendas can improve patient-provider communication, shows a study published in the Annals of Family Medicine.

Patients setting the appointment agenda has long been hailed as an effective approach to patient engagement, the researchers said. However, increasing time constrains have hindered this process, keeping patients from fully engaging with their own clinician notes.

“Collaborative agenda setting is a communication skill that helps patients identify concerns early in the clinic visit, possibly diminishing the number of ‘Oh, by the way’ items at the end of visits, and increasing patient satisfaction,” the research team wrote. “Agenda setting, however, is often limited by time constraints.”

EHRs can help overcome these barriers. When patients have access to their own clinician notes and can collaborate on them, they set the appointment agenda. Clear visit plans help providers determine appointment conversations and efficiently map out patient visits.

However, clinicians have frequently cited the EHR as an impediment to meaningful patient-provider communication, barring providers from making genuine connections with their patients.

The research team tested whether EHRs and patient data access truly detract from the patient-provider interaction at a large, primary care safety-net clinic in Seattle, Washington.

The team offered EHR notation access to all adult patients between June and July of 2015. The study excluded pediatric patients, those who could not read or write in English, and those who were not comfortable typing on a computer. Ultimately, ineligible patients constitute 26 percent of the patient population.

Prior to patient appointments, clinic staff asked patients to type their preferred appointment agendas into an electronic clinic note. Clinicians accessed the agenda note at the start of the appointment and framed the appointment from there.

Following the care encounter, patients and providers both completed surveys regarding their satisfaction with the visit. Nearly 100 patients and 28 clinicians filled out feedback surveys.

Seventy-nine percent of patients and 74 percent of providers reported that the pre-visit agenda setting improved patient-provider communication. Seventy-three percent of patients and 82 percent of providers said they wanted to continue the practice into the future.

Providers were better able to tailor discussions to what is important for the patient while still offering their own input when patients offered input into appointment agendas prior to the visit, the researchers said. Using the EHR streamlines the process, making appointments more efficient.

Ultimately, these findings offer another effective use for EHRs during the clinical encounter, despite a sometimes-negative reputation, the researchers noted.

“Clinicians often cite inadequate visit time as a barrier to relationship development and communication with patients. Interacting with EMRs during patient interviews has also eroded clinicians’ ability to connect with patients and led to clinician dissatisfaction with clinical practice, particularly in primary care,” the team explained.

“This pilot study suggests a possible way for the EMR to offset the time and computer barriers to communication. By allowing patients to set agendas before appointments, patients and clinicians can optimize their time together,” the researchers continued.

These results mark a shift toward a joint partnership between the patient and provider. Healthcare is no longer about a paternalistic patient-provider relationship, but instead about a team-based relationship that extends throughout the entire care continuum.

“The patient cogeneration of visit notes, facilitated by new EMR functionality, reflects a shift in the authorship and ‘ownership’ of visit notes,” the researchers pointed out. “Patient-written visit agendas could increase the collaborative nature of the clinical encounter between patient and clinician, but require further study, including measurement of patient engagement and health outcomes.”

Despite the positive results, the researchers did note some considerable limitations. For example, nearly one-quarter of the clinic’s patients could not participate in the study due to inadequate computer literacy or English proficiency.

“Though not available in this study, patient navigators, peer coaches, translators, or audio and touch-screen technologies may be able to address limitations in English or computer literacy, or low vision, hearing, or comprehension,” the researchers suggested.

Overall, the study points to the effectiveness of allowing patients access to their EHRs and clinician notes. Previous research has confirmed that patient data access helps improve patient understanding of their conditions and overall engagement.

This new research builds upon that argument and suggests that allowing patients to contribute to those notes by setting appointment agendas drives meaningful patient-provider communication and visit efficiency.