EHR and Patient Centered Care: Perfect Combination for High Quality Care
In order to provide high quality care, one of the aims of delivering quality care is that the healthcare system should be patient centered. This article describes how patient centered care combined with EHR can achieve high quality care.
Efficient EHRs enhance quality care
Electronic Health Record (EHR) is the electronic version of a patient’s paper health record. The main purpose of EHR is to store, manage, and retrieve information. A typical EHR will store information such as patient’s vital signs, demographics, clinical, financial, drug-related, allergy, and adverse drug reactions etc. Increased use of efficient EHRs that consist of particular characteristics chosen according to the needs of physician practices are shown to improve quality of care for patients (1).
EHR and patient and relationship centered care (PRCC)
EHRs and patient and relationship centered care (PRCC) when applied together have myriad of advantages in delivering high quality of care. PRCC stresses on paying attention to the connection and information exchange among patients, their loved ones, and physicians. Allowing patients to see selected portions of EHR and electronic message exchange between patients and physicians has shown to create a positive relationship between them2. The advantages of PRCC include: 1- Patients completing their medicine course and conforming to the planned course of medical care, 2- Enhanced patient satisfaction and health outcomes.(3)
EHR use at the point of care
Ideally, the clinicians should enter the patient information into the EHR while they are with the patient in the exam room i.e., at the point of care. Documenting the information at the same time when it is being generated avoids any mistakes or confusion and is also believed to affect quality of care in a positive way (4). But it can be difficult to concentrate on the patient while juggling attention between the patient and the EHR and as a result can have negative impact on the patient-physician relationship. The negative impact can be lessened by using a well-designed EHR and learning to manipulate the EHR while giving full attention to the patient in the exam room (5).
Tips for patient centered care using EHR at the point of care
Following are some words of advice for physicians on how to provide patient-centered care while using the EHR at the point of care (5)(6):
Use handheld devices such as laptops or tablets and movable flat-screen monitors instead of bulky and immobile computers. Familiarize yourself with internet surfing, basic computer skills and most importantly: learn typing, to keep data entry a smooth process.(5)(6)
Primary focus of the interview should be on the patient. Computer screen should be secondary and should be ignored when needed. Avoid using templates for patient interviews. Templates are great for data entry but are incapable of capturing the details of patient-provider meeting.(6)
The job of documenting regular patient information should be assigned to nurses and clinical assistants to complete before the interview. Thus during the physician-patient interview more time can be spent focusing on the patient’s problem. Sometimes the physician does not get time to look at the EHR for patient notes before the interview. In such cases, it is better to talk to the patient about his/her problems or concerns immediately after entering the exam room before getting involved with the computer.(6)
The patient should be informed about the physician’s moves in the exam room. For example, it is better to tell the patient what one is looking at on the computer screen instead of browsing, typing, or staring at the computer screen quietly. While showing the computer screen to the patient, the physician should indicate the exact point that he/she wants to show. Involve the patient when filling information in their charts by asking if they want to look at the information that has been entered and if they are fine with the result.(6)
Thus EHR use applied with patient centered care can be beneficial in delivering quality care.
1. Poon EG, Wright A, Simon SR, Jenter CA, Kaushal R, Volk LA, et al. Relationship between use of electronic health record features and health care quality: results of a statewide survey Med Care 2010 Mar;48(3):203-209.
2. Hassol A, Walker JM, Kidder D, Rokita K, Young D, Pierdon S, et al. Patient Experiences and Attitudes about Access to a Patient Electronic Health Care Record and Linked Web Messaging JAMIA 2004;11(6):505-513.
3. Ventres W. B., Kooienga S., Marlin R. Patient-centered care and electronic health records: It’s still about the relationship. Fam Pract Manag. 2006 Mar;13(3):45-47.
4. Clayton, P. D., Narus, S. P., Bowes, W. A., Madsen, T. S., Wilcox, A. B., Orsmond, G., … Leckman, L. (2005). Physician use of electronic medical records: Issues and successes with direct data entry and physician productivity. AMIA Annual Symposium Proceedings, 2005, 141–145.
5. Shachak, A. and Reis, S. (2009), The impact of electronic medical records on patient–doctor communication during consultation: a narrative literature review. Journal of Evaluation in Clinical Practice, 15: 641–649.
6. Ventres W. B., Frankel R. M. EHRs in the exam room: Tips on patient-centered care. Fam Med 2010;42(5):364-6.
Submitted by Shikha Misra