- A patient-centered EHR use training course may be effective in improving patient-provider relationships in the digital health age, according to a study published in the Journal of Medical Internet Research.
The EHR has become a mainstay in healthcare, bringing with it clinical benefits and some federal reimbursement payments. But the tool can also take away from patient-centered care, leaving some providers spending more time looking at the computer than speaking with the patient.
“Given their ubiquity in practice, it is important for providers to be aware of how EHR use in clinical encounters can alter the patient-provider interaction,” a research team out of the University of Chicago said.
“Studies looking at the impact of EHR use on the patient-doctor relationship and communication have identified physician behaviors that may negatively impact the patient-doctor relationship; for example, typing during sensitive discussions and low rates of screen sharing can lead to a decrease in transparency of provider actions and patient confusion or distrust as to what their provider is doing on the computer,” the team added.
While there are some established best practices for reconciling EHR use and patient care, most healthcare organizations do not offer training courses.
When clinicians are exposed to these best practices, they can achieve better patient satisfaction scores and patient activation in care, the research team stated.
Barriers to delivering patient-centered EHR use training include reaching trainees across specialties, lack of time in already crowded curricula, lack of patient-centered EHR use curricula, and lack of trained educators.
The research team sought to create such an EHR use training program, helping to highlight best practices in patient-centered care during technology use. The training program was embedded into the University of Chicago’s Pritzker School of Medicine overarching four-hour EHR training suite.
The patient-centered training module lasted approximately 20 minutes, and included elements such as barriers to patient-centered EHR use and best practices for overcoming those barriers.
The medical school assigned the training course to all incoming interns, residents, and fellows in 2015. Trainees came from all clinical backgrounds including primary care, surgical, and specialty disciplines.
After course completion, trainees completed an 11-question likert scale questionnaire.
The trainees reported measurable improvements after completing the patient-centered EHR use training course. Efficacy in this area improved from 3.1 to 3.9 out of five, the researchers reported.
Most of the trainees also stated that the training course was essential. Ninety percent said the training was effective, 88 percent said it should be mandatory, and 71 percent said the training would alter providers’ future practice.
The researchers found that interns tended to have better self-reported knowledge of patient-centered EHR use than fellows and residents – a difference of 3.27 and 2.94 on the likert scale, the researchers said.
“It is interesting to note that interns endorsed higher prior knowledge of barriers than their more experienced peers,” the team pointed out. “It may be that younger trainees are more attuned to obstacles with EHR use, whereas their more experienced peers have developed EHR workarounds and are thus less likely to endorse barriers.”
Primary care providers tended to yield larger improvements in knowledge about patient-centered care barriers, EHR best practices, and ability to implement best practices than surgical and specialty trainees. The researchers said this points to an imperative to create a training module specific to surgical and other specialty providers.
The team also reported that it could be helpful to collect feedback from real patient encounters as a part of training.
“It is critical to provide opportunities for trainees to obtain feedback about their skills with real patients,” the team noted. “This can come in the form of direct feedback from patients themselves as well as from faculty supervisors observing their actual clinical practice. Tools such as the validated electronic Clinical Evaluation Exercise may be helpful in order to structure feedback on patient-centered EHR use behaviors and highlight areas for improvement.”
Going forward, the researchers are looking for ways to supplement the training course using hospital experts including health IT professionals and EHR trainers.
Likewise, the University of Chicago has implemented the training course as a permanent part of its medical school curricula because of the overwhelming support the researchers received form the pilot trainees.
“We found partnering with EHR trainers who deliver required onboarding training is a novel, timely, and effective method to facilitate training on patient-centered EHR communication strategies across a variety of residency and postresidency training programs,” the researchers concluded. “Similar training can be easily replicated at other institutions and may help ground trainees in best practices and contribute to cultivating a culture of high-quality patient care and meaningful, humanistic patient-centered EHR use.”