- The rise of EHR use and health technology has posed some challenges in boosting patient engagement and patient-centered care, but providers are increasingly rising to these challenges and developing strategies to overcome them.
In a recent study published in the Journal of the American Medical Informatics Association, researchers examined the barriers providers face in engaging their patients while navigating their EHRs. Through interviews with physicians and nurse practitioners at four different Veterans Affairs outpatient primary care clinics, the research team identified two categories of patient engagement barriers.
The first was meeting patient demands, including engaging the patient, meeting their specific needs, and meeting their psychosocial needs. Specifically, providers were concerned with fostering healthy and respectful communication with their patients by actively listening to them, meeting their eye contact, and forging strong relationships.
Providers also sought to meet patients’ psychosocial needs, a lingering demand at VA primary care clinics.
“The VA, in particular, has a higher prevalence of psychosocial problems among its patients, such as Post-Traumatic Stress Disorder (PTSD),” the research team explained. “When interacting with patients with mental health needs, a higher level of sensitivity is required.”
Additionally, physicians have an added workload when treating patients with psychosocial problems, including answering a set of nine standard questions in their EHRs.
Providers also reported several EHR demands, including detailed patient documentation, pop-up alerts, and notifications. There is often a lot of activity on an EHR screen, and providers need to navigate all of that to perform the necessary tasks.
Trouble arises when EHRs have usability issues. These systems are reportedly difficult to navigate, and pose several problems when a provider is looking for a specific part of the EHR or trying to accomplish a certain task.
From these two demands come a difficult conflict. Providing ethical, empathic, and patient-centered care is both a personal priority for providers, as well as a financial one in a value-based reimbursement setting. However, with the rise of the EHR Incentive Programs, providers must work diligently to meet certain EHR use benchmarks.
While this conflict is an oft-cited one, the researchers acknowledged that there was little information regarding how providers overcome patient engagement and EHR use challenges. During their investigative interviews, the researchers determine some of the providers’ best practices for integrating their EHRs into a patient-centered care encounter.
Between working outside of the care encounter and trying to use the EHR as a tool to boost patient engagement, providers reported some strategies to improve patient-centered care.
Documenting between clinical encounters
One of the foremost strategies to integrate EHRs into patient-centered care was to document in the EHR between the care encounter. Several providers reported skipping lunch or working beyond traditional office hours in order to document outside of the clinical encounter, freeing up their time with the patient for patient-centered care.
“In our interviews, the majority of providers performed EHR work outside of patient visits to alleviate time pressure,” the researchers reported.
“These outside-of-visit EHR activities include previewing, documenting, reviewing, and finishing notes. Based on their priorities, schedule and work habits, some providers spent more time previewing patients’ notes before visits. Similarly, some providers manage the competing demands in the exam-room by documenting in their notes after the visits.”
Document template use
Providers also worked to streamline the documentation process through the use of EHR templates. By using pre-filled templates, providers only needed to focus on individualized patient information, and were able to take more time during the visit to focus on patient needs.
Some providers said the use of templates also worked well to remind them of data collected from past care encounters that they may have wanted to follow up.
Using the EHR as a patient engagement tool
Some providers reported that they seamlessly integrated the EHR into the care encounter as a patient engagement tool. Through screen sharing, providers were able to show patients their own personal health data, educating them on their well-being. Providers specifically used graphs and other visual elements to engage their patients.
Bolstering patient buy-in for technology
While there was no reported evidence that patients did or did not like EHRs in this study, providers reported that making patients aware of the benefits of the technology made them more understanding of providers’ split focus between them and the computer screen.
“Thus, some providers articulated EHR activities with the patients to gain their understanding and buy-in for EHR use during visits,” the researchers noted. “This transparency in communication helps alleviate demands from patients. Most providers feel that once they establish patient buy-in of anticipated EHR activities, both providers and patients are more at ease with EHR use.”
Providers practice general multitasking
Beyond specific efforts to integrate EHRs into clinical practice, a majority of providers also attempted to generally multitask. According to the researchers, providers began small talk while documenting in the EHR, or entering patient data while the patient was speaking.
Overall, this help providers meet both patient and EHR demands.
While there are undoubtedly notable benefits to physician EHR use, providers still need to focus on strategies to integrate their technology into clinical workflow. According to the research team, these tips will go a long way in boosting patient satisfaction, all while bolstering EHR use in the physician’s office.
“By identifying the challenges providers have encountered with the use of the EHR, and strategies they use to overcome these challenges, we were able to gain a better understanding of the providers’ behaviors in exam rooms, thus providing more concrete suggestions to balance the demands,” the researchers concluded. “We believe that, if used strategically, EHRs can have the potential to facilitate patient-provider interaction and patient engagement.”