EHRs and Consumer Engagement: Part 1

By: Sabrina Beroz

The motivation for this three-part series on electronic health record (EHR) engagement arose from a personal experience at the motor vehicle administration. After waiting for hours to acquire Real ID status, I finally arrived at the counter where the employee took my documents, scanned them into the computer, and handed back my updated driver’s license – all without any eye contact during our entire interaction. Walking away, I reflected on the experience, wondering how patients/consumers feel when faced with similar encounters. Do health care professionals manage the technological Everest and patient engagement well? Part 1 of this series looks at consumer versus technology engagement. Parts 2 and 3 will focus on health care providers and nursing education.

Gone are the days of paper! Today, we use electronic health records in acute care, chronic care, and community settings. The sharing of information, care coordination, patient safety, patient empowerment, and self-management has resulted in numerous benefits echoed in the NLN Vision Statement, A Vision for the Changing Faculty Role: Preparing Students for the Technological World of Health Care.

The Quality and Safety Education for Nurses Institute (QSEN) (2019) defines two important competencies related to the EHR: Patient-Centered Care and Informatics. Patient-centered care appreciates the patient as a full partner with the health care team. Compassionate care is provided based on respect for the individual’s preferences and values. Patient-centered care is key to patient engagement and the provider-patient interaction and leads to positive outcomes. Informatics uses technology to communicate, share and manage information, mitigate error, and enhance decision-making. Common to both competencies is communication with and between the patient/consumer and the EHR (QSEN, 2019).

In a systematic review of patient-centered communication and EHRs, it is shown that training alone is insufficient to address disruptions in communication between health care providers and consumers/patients (Rathert et al., 2017). Rathert and colleagues conclude that research is needed to examine the impact of EHRs on communication and the achievement of patient-centered care. In another study, where EHRs were used extensively, patients used a five-point Likert scale (1= least satisfied, 5 = highly  satisfied) to rate satisfaction in patient-centered communication, clinical skills, and interpersonal skills. Farber and colleagues (2015) found that patients rated all three areas as highly satisfied. Patient satisfaction with patient-centered communication was significantly associated with gaze time (eye contact); the more gaze time with the patient/consumer, the greater the patient satisfaction. Unfortunately, only a few studies have examined the effects of EHRs on the patient/consumer experience, and the findings have not yielded consistent results.

What we do know is: EHRs are here to stay. The benefits to care coordination, knowledge sharing, and patient safety are clear. As technology and EHRs remain an integral part of practice, health care professionals must balance the impact of technology on consumer/patient  satisfaction with patient-centered care and communication. Be sure to check back for Part 2 of this series as we look at provider engagement and EHRs.


References

Farber, N., Liu, L., Chen, Y., Calvitti, A., Street, R., Zuest, D., Bell, K., Gabuzda, M., Gray, B., Ashfag, S., & Agha, Z. (2015). EHR use and patient satisfaction: What we learned. Journal of Family Practice, 64(11), 687-696.

National League for Nursing. (2015). A vision for the changing faculty role: Preparing students for the technological world of health care. http://www.nln.org/newsroom/nln-position-documents/nln-living-documents

Quality and Safety Education for Nurses. (2020). QSEN competencies. https://qsen.org/

Rathert, C., Mittler, J.N., Banerjee, S., & McDaniel, J. (2017). Patient-centered communication in the era of electronic health records: What does the evidence say? Patient Education and Counseling, 100(1) 50-64. doi:10.1016/j.pec.2016.07.031

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