EMR use to support Patient Centered Care

Patient Centered Care

Patient centered care is the crux of the push towards the Patient Centered Medical Home, which is the NCQA's 2011 program to help transform and improve primary care. In this concept, the practice is structured around meeting the needs of the patient by the use of a team based approach. A patient can access care from the physician, but may also interact directly in different ways too. Examples include speaking with a dietician regarding weight management, or clinical pharmacist to help adjust diabetic meds for example.

Patient Health Portal

Portals of access also include the patient health portal, where a patient can review their medication list, problem list, and prior after visit summaries, or access a database to look up information about health related problems, or disease processes. Portals can also allow patients to make their own appointments, and also to contact their PCP for an "e-visit" or to email the physician with a question.

EMR use in exam rooms

Computer use can facilitate a patient visit, rather than be a barrier. The computer screen forms a physical barrier between the doctor and patient, and so positioning of the computer is important. Forming a triangle that allows the screen to be shared is an important way to allow the patient to view data on the screen as well as reduces patient anxiety about what the physician is doing on the computer. A physician can review the medication list effectively with a patient looking on and confirm with the patient the medications and the dosing that are on the list. Similarly the problem list can be used in the same way. Additionally, graphing capabilities allow a patient to visualize lab results or vitals effectively and understand their progress in disease management. Spatial organization can therefore facilitate communication. [1]

Patient centered EMR design

The design of an EMR can facilitate patient centeredness. One article by Nusbaum suggests that there are three possible target areas that may facilitate patient centeredness when an EMR is developed. The author quoted these as the development of the chief complaint, the establishment of level of patient literacy and the assistance by the EMR of health screening. [2]

After visit summary

The after visit summary has become an important core objective in the meaningful use requirements. The measure requires that over 50 percent of all patient office visits are provided with a clinical summary within 3 business days. This can be provided in paper form or electronic form. Patient often forget about 50% or more of their instruction at the end of their office visit and provision of a summary helps the patients (and relatives at home) to remember the main points. Older adults and those with literacy problems have significantly greater difficulty than others. [3]

Conclusion

The training of physicians to effectively use an EMR can help doctor-patient communication. Correct positioning of an EMR can make a visit more interactive for patients while collaboration can promote patient participation and involvement in their own health management.[4]

References

1: Frankel R, Altschuler A, George S, Kinsman J, Jimison H, Robertson NR, Hsu J.

Effects of exam-room computing on clinician-patient communication: a longitudinal qualitative study. J Gen Intern Med. 2005 Aug;20(8):677-82.

2: Nusbaum NJ. The electronic medical record and Patient-centered care. Online J Public Health Inform. 2011;3(2). doi:pii: ojphi.v3i2.3721. 10.5210/ojphi.v3i2.3721. Epub 2011 Nov 7.

3: McCarthy, Danielle M.; Waite, Katherine R.; Curtis, Laura M.; Engel, Kirsten G.; Baker, David W.; Wolf, Michael S. What Did the Doctor Say? Health Literacy and Recall of Medical Instructions. Medical Care. 50(4):277-282, April 2012. doi: 0.1097/MLR.0b013e318241e8e1

4: Margalit RS, Roter D, Dunevant MA, Larson S, Reis S. Electronic medical record use and physician-patient communication: an observational study of Israeli primary care encounters. Patient Educ Couns. 20

Submitted by Bhavesh Rajani MD