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Kachman MM, Brennan I, Oskvarek JJ, Waseem T, Pines JM. How artificial intelligence could transform emergency care. Am J Emerg Med 2024; 81:40-46. [PMID: 38663302 DOI: 10.1016/j.ajem.2024.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/13/2024] [Accepted: 04/15/2024] [Indexed: 06/07/2024] Open
Abstract
Artificial intelligence (AI) in healthcare is the ability of a computer to perform tasks typically associated with clinical care (e.g. medical decision-making and documentation). AI will soon be integrated into an increasing number of healthcare applications, including elements of emergency department (ED) care. Here, we describe the basics of AI, various categories of its functions (including machine learning and natural language processing) and review emerging and potential future use-cases for emergency care. For example, AI-assisted symptom checkers could help direct patients to the appropriate setting, models could assist in assigning triage levels, and ambient AI systems could document clinical encounters. AI could also help provide focused summaries of charts, summarize encounters for hand-offs, and create discharge instructions with an appropriate language and reading level. Additional use cases include medical decision making for decision rules, real-time models that predict clinical deterioration or sepsis, and efficient extraction of unstructured data for coding, billing, research, and quality initiatives. We discuss the potential transformative benefits of AI, as well as the concerns regarding its use (e.g. privacy, data accuracy, and the potential for changing the doctor-patient relationship).
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Affiliation(s)
- Marika M Kachman
- US Acute Care Solutions, Canton, OH, United States of America; Department of Emergency Medicine, Virginia Hospital Center, Arlington, VA, United States of America
| | - Irina Brennan
- US Acute Care Solutions, Canton, OH, United States of America; Department of Emergency Medicine, Inova Alexandria Hospital, Alexandria, VA, United States of America
| | - Jonathan J Oskvarek
- US Acute Care Solutions, Canton, OH, United States of America; Department of Emergency Medicine, Summa Health, Akron, OH, United States of America
| | - Tayab Waseem
- Department of Emergency Medicine, George Washington University, Washington, DC, United States of America
| | - Jesse M Pines
- US Acute Care Solutions, Canton, OH, United States of America; Department of Emergency Medicine, George Washington University, Washington, DC, United States of America.
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Ford J, Reuber M. Face-to-face and telephone appointments in the seizure clinic: A comparative analysis based on recorded interactions. PATIENT EDUCATION AND COUNSELING 2024; 123:108171. [PMID: 38368785 DOI: 10.1016/j.pec.2024.108171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 11/10/2023] [Accepted: 01/21/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVE Telephone appointments are now widely used in seizure treatment, but there is little understanding of how they compare to face-to-face appointments. Studies from other fields suggest that comparisons can be done on three levels: 1) Abstract level: duration of appointment. 2) Structural level: distribution of talk. 3) Detailed level: aspects of communication. This study aims to compare seizure clinic face-to-face and telephone appointments based on their duration, distribution of talk, and the number of questions asked by patients/companions. METHODS Statistical comparison between recordings and transcripts of 34 telephone appointments (recorded in 2021) and 56 face-to-face appointments (recorded in 2013). RESULTS There was no significant difference between the duration of face-to-face (median: 16.5 min) and telephone appointments (median: 16.2 min). There was no significant difference in the ratio of neurologist to patient/companion talk (face-to-face: 55% vs. 45%, telephone: 54% vs. 46%). Patients/companions asked significantly more questions per minute in face-to-face (median: 0.17) than telephone appointments (median: 0.06, p < 0.05). CONCLUSION At a broad level, seizure clinic face-to-face and telephone appointments are similar. Examining the details of the interaction, however, reveals important differences in questioning. PRACTICE IMPLICATIONS Practitioners could take steps to facilitate patient questioning in telephone appointments.
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Affiliation(s)
- Joseph Ford
- Department of Neuroscience, University of Sheffield, UK.
| | - Markus Reuber
- Department of Neuroscience, University of Sheffield, UK
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Joseph D, Hu R, Min R, Jolly M, Hassan S. Use and Utility of Patient After-Visit Instructions at a University Rheumatology Outpatient Clinic: Status and Randomized Prospective Pilot Intervention Study. ACR Open Rheumatol 2024; 6:321-329. [PMID: 38387613 PMCID: PMC11089441 DOI: 10.1002/acr2.11659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 01/11/2024] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the use of after-visit instructions (AVIs) in an academic rheumatology clinic and assess the impact of standardized AVIs (sAVIs) and teach-back (TB) on comprehension of health information. METHODS A retrospective review of adult patients seen between October 1 and 8, 2021, at the rheumatology clinic collected data on patient demographics, clinical features, and the presence, content, and readability of AVIs. During a subsequent prospective proof-of-concept study, routinely scheduled patients seen at the rheumatology clinic were randomized into three groups: control (received standard of care), received sAVIs only, and received sAVIs plus TB. Patients completed a health literacy questionnaire, satisfaction survey, and a one- to two-week postvisit telephone survey to assess AVI comprehension. RESULTS Out of 316 retrospective patient visits, 82 (25.9%) received AVIs. Among 210 of 316 patients (66.5%) with management changes, 76 (36.1%) received AVI, with 74.2% of the instructions considered concordant with the provider's note. Use of AVIs was higher with management changes, new patient visits, and medical trainee/teaching clinics. AVIs were written at a median 6.8 grade level. A total of 75 patients completed the prospective study: 31 (41.3%) were in the control group, 19 (25.3%) were in the group that received sAVIs only, and 25 (33.3%) were in the group that received AVIs with TB. There were no differences in overall postvisit survey comprehension/retention scores among the three patient groups evaluated. CONCLUSION Although a lack of AVI use was identified, implementation of sAVIs did not appear to impact patient retention or comprehension of discharge health information.
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Affiliation(s)
- Dijo Joseph
- Rush University Medical CenterChicagoIllinois
| | - Rong Hu
- Rush University Medical CenterChicagoIllinois
| | - Robert Min
- Rush University Medical CenterChicagoIllinois
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Färber A, Schwabe C, Stalder PH, Dolata M, Schwabe G. Physicians' and Patients' Expectations From Digital Agents for Consultations: Interview Study Among Physicians and Patients. JMIR Hum Factors 2024; 11:e49647. [PMID: 38498022 PMCID: PMC10985611 DOI: 10.2196/49647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 12/09/2023] [Accepted: 01/15/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Physicians are currently overwhelmed by administrative tasks and spend very little time in consultations with patients, which hampers health literacy, shared decision-making, and treatment adherence. OBJECTIVE This study aims to examine whether digital agents constructed using fast-evolving generative artificial intelligence, such as ChatGPT, have the potential to improve consultations, adherence to treatment, and health literacy. We interviewed patients and physicians to obtain their opinions about 3 digital agents-a silent digital expert, a communicative digital expert, and a digital companion (DC). METHODS We conducted in-depth interviews with 25 patients and 22 physicians from a purposeful sample, with the patients having a wide age range and coming from different educational backgrounds and the physicians having different medical specialties. Transcripts of the interviews were deductively coded using MAXQDA (VERBI Software GmbH) and then summarized according to code and interview before being clustered for interpretation. RESULTS Statements from patients and physicians were categorized according to three consultation phases: (1) silent and communicative digital experts that are part of the consultation, (2) digital experts that hand over to a DC, and (3) DCs that support patients in the period between consultations. Overall, patients and physicians were open to these forms of digital support but had reservations about all 3 agents. CONCLUSIONS Ultimately, we derived 9 requirements for designing digital agents to support consultations, treatment adherence, and health literacy based on the literature and our qualitative findings.
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Affiliation(s)
- Andri Färber
- ZHAW School of Management and Law, Zurich University of Applied Sciences, Winterthur, Switzerland
- Department of Informatics, University of Zurich, Zurich, Switzerland
| | | | - Philipp H Stalder
- ZHAW School of Management and Law, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Mateusz Dolata
- Department of Informatics, University of Zurich, Zurich, Switzerland
| | - Gerhard Schwabe
- Department of Informatics, University of Zurich, Zurich, Switzerland
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Canfell OJ, Woods L, Meshkat Y, Krivit J, Gunashanhar B, Slade C, Burton-Jones A, Sullivan C. The Impact of Digital Hospitals on Patient and Clinician Experience: Systematic Review and Qualitative Evidence Synthesis. J Med Internet Res 2024; 26:e47715. [PMID: 38466978 DOI: 10.2196/47715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 11/08/2023] [Accepted: 01/31/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND The digital transformation of health care is advancing rapidly. A well-accepted framework for health care improvement is the Quadruple Aim: improved clinician experience, improved patient experience, improved population health, and reduced health care costs. Hospitals are attempting to improve care by using digital technologies, but the effectiveness of these technologies is often only measured against cost and quality indicators, and less is known about the clinician and patient experience. OBJECTIVE This study aims to conduct a systematic review and qualitative evidence synthesis to assess the clinician and patient experience of digital hospitals. METHODS The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and ENTREQ (Enhancing the Transparency in Reporting the Synthesis of Qualitative Research) guidelines were followed. The PubMed, Embase, Scopus, CINAHL, and PsycINFO databases were searched from January 2010 to June 2022. Studies that explored multidisciplinary clinician or adult inpatient experiences of digital hospitals (with a full electronic medical record) were included. Study quality was assessed using the Mixed Methods Appraisal Tool. Data synthesis was performed narratively for quantitative studies. Qualitative evidence synthesis was performed via (1) automated machine learning text analytics using Leximancer (Leximancer Pty Ltd) and (2) researcher-led inductive synthesis to generate themes. RESULTS A total of 61 studies (n=39, 64% quantitative; n=15, 25% qualitative; and n=7, 11% mixed methods) were included. Most studies (55/61, 90%) investigated clinician experiences, whereas few (10/61, 16%) investigated patient experiences. The study populations ranged from 8 to 3610 clinicians, 11 to 34,425 patients, and 5 to 2836 hospitals. Quantitative outcomes indicated that clinicians had a positive overall satisfaction (17/24, 71% of the studies) with digital hospitals, and most studies (11/19, 58%) reported a positive sentiment toward usability. Data accessibility was reported positively, whereas adaptation, clinician-patient interaction, and workload burnout were reported negatively. The effects of digital hospitals on patient safety and clinicians' ability to deliver patient care were mixed. The qualitative evidence synthesis of clinician experience studies (18/61, 30%) generated 7 themes: inefficient digital documentation, inconsistent data quality, disruptions to conventional health care relationships, acceptance, safety versus risk, reliance on hybrid (digital and paper) workflows, and patient data privacy. There was weak evidence of a positive association between digital hospitals and patient satisfaction scores. CONCLUSIONS Clinicians' experience of digital hospitals appears positive according to high-level indicators (eg, overall satisfaction and data accessibility), but the qualitative evidence synthesis revealed substantive tensions. There is insufficient evidence to draw a definitive conclusion on the patient experience within digital hospitals, but indications appear positive or agnostic. Future research must prioritize equitable investigation and definition of the digital clinician and patient experience to achieve the Quadruple Aim of health care.
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Affiliation(s)
- Oliver J Canfell
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Digital Health Cooperative Research Centre, Australian Government, Sydney, Australia
- UQ Business School, Faculty of Business, Economics and Law, The University of Queensland, Brisbane, Australia
| | - Leanna Woods
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Yasaman Meshkat
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Jenna Krivit
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Brinda Gunashanhar
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Christine Slade
- Institute for Teaching and Learning Innovation, The University of Queensland, Brisbane, Australia
| | - Andrew Burton-Jones
- UQ Business School, Faculty of Business, Economics and Law, The University of Queensland, Brisbane, Australia
| | - Clair Sullivan
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Queensland Digital Health Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Metro North Hospital and Health Service, Department of Health, Queensland Government, Brisbane, Australia
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Ramachandran M, Brinton C, Wiljer D, Upshur R, Gray CS. The impact of eHealth on relationships and trust in primary care: a review of reviews. BMC PRIMARY CARE 2023; 24:228. [PMID: 37919688 PMCID: PMC10623772 DOI: 10.1186/s12875-023-02176-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 10/11/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Given the increasing integration of digital health technologies in team-based primary care, this review aimed at understanding the impact of eHealth on patient-provider and provider-provider relationships. METHODS A review of reviews was conducted on three databases to identify papers published in English from 2008 onwards. The impact of different types of eHealth on relationships and trust and the factors influencing the impact were thematically analyzed. RESULTS A total of 79 reviews were included. Patient-provider relationships were discussed more frequently as compared to provider-provider relationships. Communication systems like telemedicine were the most discussed type of technology. eHealth was found to have both positive and negative impacts on relationships and/or trust. This impact was influenced by a range of patient-related, provider-related, technology-related, and organizational factors, such as patient sociodemographics, provider communication skills, technology design, and organizational technology implementation, respectively. CONCLUSIONS Recommendations are provided for effective and equitable technology selection, application, and training to optimize the impact of eHealth on relationships and trust. The review findings can inform providers' and policymakers' decision-making around the use of eHealth in primary care delivery to facilitate relationship-building.
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Affiliation(s)
- Meena Ramachandran
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada.
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, QC, H3G 1Y5, Canada.
| | - Christopher Brinton
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
- Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - David Wiljer
- Education Technology Innovation, University Health Network, 190 Elizabeth St, Toronto, ON, M5G 2C4, Canada
- Department of Psychiatry, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
- Centre for Addiction and Mental Health, 1000 Queen St W, Toronto, ON, M6J 1H4, Canada
| | - Ross Upshur
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
| | - Carolyn Steele Gray
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
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Joa B. Physician Ownership for the Virtuous Practice of Medicine. LINACRE QUARTERLY 2023; 90:408-421. [PMID: 37974575 PMCID: PMC10638960 DOI: 10.1177/00243639231190133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
The shift from physicians as owners or shareholders of practices to being employees of corporations is now a widespread trend with over 50% of physicians now considered employees. If continued, this trend will have profound effects on the medical profession and on physicians' personal lifestyles and sense of agency. However, ownership is not a morally neutral consideration but is important for safeguarding the traditions of virtue in the medical profession. Virtue develops within localized communities of practice and thrives in settings that embody principles such as solidarity, subsidiarity, and participation found in Catholic social teaching. Ownership increases physicians' investment in moral communities where they practice, affording physicians greater agency to benefit these communities according to their best judgment. This ownership can vary by type of organization and degree of shareholding. Because moral communities are the settings in which physicians form virtue, and ownership increases physicians' commitment and investment in communities, I make a principled argument that physicians who value developing virtue should consider having ownership of their practices when planning their careers. Ownership will be an important aspect of any medical ethics based on virtue rather than on principlism.
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Affiliation(s)
- Brandon Joa
- Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, PA, USA
- Theology and Religious Studies, Villanova University College of Liberal Arts and Sciences, Villanova, PA, USA
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Tabche C, Raheem M, Alolaqi A, Rawaf S. Effect of electronic health records on doctor-patient relationship in Arabian gulf countries: a systematic review. Front Digit Health 2023; 5:1252227. [PMID: 37877127 PMCID: PMC10593471 DOI: 10.3389/fdgth.2023.1252227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/22/2023] [Indexed: 10/26/2023] Open
Abstract
Background The electronic health record (EHR) has been widely implemented internationally as a tool to improve health and healthcare delivery. However, EHR implementation has been comparatively slow amongst hospitals in the Arabian Gulf countries. This gradual uptake may be linked to prevailing opinions amongst medical practitioners. Until now, no systematic review has been conducted to identify the impact of EHRs on doctor-patient relationships and attitudes in the Arabian Gulf countries. Objective To understand the impact of EHR use on patient-doctor relationships and communication in the Arabian Gulf countries. Design A systematic review of English language publications was performed using PRISMA chart guidelines between 1990 and 2023. Methods Electronic database search (Ovid MEDLINE, Global Health, HMIC, EMRIM, and PsycINFO) and reference searching restricted to the six Arabian Gulf countries only. MeSH terms and keywords related to electronic health records, doctor-patient communication, and relationship were used. Newcastle-Ottawa Scale (NOS) quality assessment was performed. Results 18 studies fulfilled the criteria to be included in the systematic review. They were published between 1992 and 2023. Overall, a positive impact of EHR uptake was reported within the Gulf countries studied. This included improvement in the quality and performance of physicians, as well as improved accuracy in monitoring patient health. On the other hand, a notable negative impact was a general perception of physician attention shifted away from the patients themselves and towards data entry tasks (e.g., details of the patients and their education at the time of the consultation). Conclusion The implementation of EHR systems is beneficial for effective care delivery by doctors in Gulf countries despite some patients' perception of decreased attention. The use of EHR assists doctors with recording patient details, including medication and treatment procedures, as well as their outcomes. Based on this study, the authors conclude that widespread EHR implementation is highly recommended, yet specific training should be provided, and the subsequent effect on adoption rates by all users must be evaluated (particularly physicians). The COVID-19 Pandemic showed the great value of EHR in accessing information and consulting patients remotely.
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Conroy M, Kamaraju S, Powell M, Harris A, Beckius A, Nagavally S, Dawson A, Min H, Wright T, Wainaina N, Binder AF. Racial and Ethnic Differences in the Use of Electronic Medical Record Messaging Among Patients With Breast Cancer: A Quality Improvement Study. Clin Breast Cancer 2023; 23:e434-e440. [PMID: 37482498 DOI: 10.1016/j.clbc.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/30/2023] [Accepted: 07/01/2023] [Indexed: 07/25/2023]
Abstract
INTRODUCTION Despite evidence that use of electronic medical record (EMR) messaging positively impacts patients with cancer, there is little research on utilization patterns. The objective of this study is to describe the use of EMR messaging among breast cancer patients so that future interventions may be developed and targeted appropriately. MATERIALS AND METHODS Sociodemographic and MyChart usage data were collected. Study eligibility included patients who completed a visit at an academic breast center and sent at least one message to a provider during the study period (May 2021-May 2022). Chi-square and t-tests were used to describe differences between users and nonusers of EMR messaging. ANOVA and chi-square were used to describe differences between race/ethnicity. RESULTS A total of 4069 patients with activated MyChart accounts were included in the analysis. About 3575 (87.9%) were messaging users and 494 (12.1%) were nonusers. The mean age of users was significantly lower compared to the nonusers (57.7 vs 61.2, P< .001). Compared to non-Hispanic White (NHW) individuals, non-Hispanic Black (NHB) (odds ratio [OR]: 0.38, CI [0.21, 0.37]) and Hispanic individuals (OR: 0.35, CI [0.22, 0.57]) were significantly less likely to use electronic messaging. There were statistically significant racial/ethnic differences in the types of messages sent among EMR users. CONCLUSION Our study shows disparate EMR messaging utilization based on age, race, and primary language. As the availability of patient portals and electronic messaging increase, it is important to understand the barriers that patients face so that they can be addressed.
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Affiliation(s)
| | - Sailaja Kamaraju
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI; Froedtert Hospital, Milwaukee, WI; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | | | | | - Anna Beckius
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Sneha Nagavally
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Aprill Dawson
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Heun Min
- Medical College of Wisconsin, Milwaukee, WI
| | | | - Njeri Wainaina
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Adam F Binder
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
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Almansour A, Montague E, Furst J, Raicu D. Evaluation of Eye Gaze Dynamics During Physician-Patient-Computer Interaction in Federally Qualified Health Centers: Systematic Analysis. JMIR Hum Factors 2023; 10:e46120. [PMID: 37682590 PMCID: PMC10517387 DOI: 10.2196/46120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/08/2023] [Accepted: 08/02/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Understanding the communication between physicians and patients can identify areas where they can improve and build stronger relationships. This led to better patient outcomes including increased engagement, enhanced adherence to treatment plan, and a boost in trust. OBJECTIVE This study investigates eye gaze directions of physicians, patients, and computers in naturalistic medical encounters at Federally Qualified Health Centers to understand communication patterns given different patients' diverse backgrounds. The aim is to support the building and designing of health information technologies, which will facilitate the improvement of patient outcomes. METHODS Data were obtained from 77 videotaped medical encounters in 2014 from 3 Federally Qualified Health Centers in Chicago, Illinois, that included 11 physicians and 77 patients. Self-reported surveys were collected from physicians and patients. A systematic analysis approach was used to thoroughly examine and analyze the data. The dynamics of eye gazes during interactions between physicians, patients, and computers were evaluated using the lag sequential analysis method. The objective of the study was to identify significant behavior patterns from the 6 predefined patterns initiated by both physicians and patients. The association between eye gaze patterns was examined using the Pearson chi-square test and the Yule Q test. RESULTS The results of the lag sequential method showed that 3 out of 6 doctor-initiated gaze patterns were followed by patient-response gaze patterns. Moreover, 4 out of 6 patient-initiated patterns were significantly followed by doctor-response gaze patterns. Unlike the findings in previous studies, doctor-initiated eye gaze behavior patterns were not leading patients' eye gaze. Moreover, patient-initiated eye gaze behavior patterns were significant in certain circumstances, particularly when interacting with physicians. CONCLUSIONS This study examined several physician-patient-computer interaction patterns in naturalistic settings using lag sequential analysis. The data indicated a significant influence of the patients' gazes on physicians. The findings revealed that physicians demonstrated a higher tendency to engage with patients by reciprocating the patient's eye gaze when the patient looked at them. However, the reverse pattern was not observed, suggesting a lack of reciprocal gaze from patients toward physicians and a tendency to not direct their gaze toward a specific object. Furthermore, patients exhibited a preference for the computer when physicians directed their eye gaze toward it.
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Affiliation(s)
- Amal Almansour
- Jarvis College of Computing and Digital Media, DePaul University, Chicago, IL, United States
| | - Enid Montague
- Department of Mechanical & Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Jacob Furst
- Jarvis College of Computing and Digital Media, DePaul University, Chicago, IL, United States
| | - Daniela Raicu
- Jarvis College of Computing and Digital Media, DePaul University, Chicago, IL, United States
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Marino F, Alby F, Zucchermaglio C, Fatigante M. Digital technology in medical visits: a critical review of its impact on doctor-patient communication. Front Psychiatry 2023; 14:1226225. [PMID: 37575567 PMCID: PMC10412815 DOI: 10.3389/fpsyt.2023.1226225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
With the rapid advances of digital technology, computer-mediated medical practices are becoming increasingly dominant in medical visits. However, the question of how to ensure effective, patient-centered communication in this transition remains crucial. In this mini-review, we explore this topic by reviewing quantitative and survey-based studies, as well as discursive-interactional studies that focus on the visit as a communicative event. The review is organized into four sections: the introductory section provides a brief synthesis of the two main models used in medical practice and describes the effects of patient-centered communication practices on patients' health and well-being. The second section presents and discusses qualitative and quantitative studies that assess the effect of technology on medical interaction and its impact on patient-centered communication. The third section focuses on whether and how the digital medical record represents a "potential communication risk" during doctor-patient interactions and explores how certain pen-and-paper literacy practices could help mitigate these challenges. In the concluding section, we outline and analyze three key considerations for utilizing technologies to foster and enhance patient-centered communication during medical visits.
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Affiliation(s)
- Filomena Marino
- Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy
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Chen KCJ, Bartman I, Pugh D, Topps D, Desjardins I, Forgie M, Archibald D. Experience of introducing an electronic health records station in an objective structured clinical examination to evaluate medical students’ communication skills in Canada: a descriptive study. JOURNAL OF EDUCATIONAL EVALUATION FOR HEALTH PROFESSIONS 2023; 20:22. [PMID: 37400976 PMCID: PMC10442496 DOI: 10.3352/jeehp.2023.20.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/03/2023] [Indexed: 07/05/2023]
Abstract
PURPOSE There is limited literature related to the assessment of electronic medical record (EMR)-related competencies. To address this gap, this study explored the feasibility of an EMR objective structured clinical examination (OSCE) station to evaluate medical students’ communication skills by psychometric analyses and standardized patients’ (SPs) perspectives on EMR use in an OSCE. METHODS An OSCE station that incorporated the use of an EMR was developed and pilot-tested in March 2020. Students’ communication skills were assessed by SPs and physician examiners. Students’ scores were compared between the EMR station and 9 other stations. A psychometric analysis, including item total correlation, was done. SPs participated in a post-OSCE focus group to discuss their perception of EMRs’ effect on communication. RESULTS Ninety-nine 3rd-year medical students participated in a 10-station OSCE that included the use of the EMR station. The EMR station had an acceptable item total correlation (0.217). Students who leveraged graphical displays in counseling received higher OSCE station scores from the SPs (P=0.041). The thematic analysis of SPs’ perceptions of students’ EMR use from the focus group revealed the following domains of themes: technology, communication, case design, ownership of health information, and timing of EMR usage. CONCLUSION This study demonstrated the feasibility of incorporating EMR in assessing learner communication skills in an OSCE. The EMR station had acceptable psychometric characteristics. Some medical students were able to efficiently use the EMRs as an aid in patient counseling. Teaching students how to be patient-centered even in the presence of technology may promote engagement.
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Affiliation(s)
- Kuan-chin Jean Chen
- Department of Emergency Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Debra Pugh
- Medical Council of Canada, Ottawa, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - David Topps
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Isabelle Desjardins
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Melissa Forgie
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Douglas Archibald
- Department of Family Medicine, Department of Innovation in Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Abegaz AK, Tamire AH, Asfaw H. Caregivers' Satisfaction of Teleconsultations and Associated Factors During COVID-19 Pandemic at Pediatric Clinics of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A Cross-Sectional Study. Pediatric Health Med Ther 2023; 14:185-196. [PMID: 37273412 PMCID: PMC10237277 DOI: 10.2147/phmt.s402924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/04/2023] [Indexed: 06/06/2023] Open
Abstract
Background The COVID-19 pandemic led to a paradigm shift in routine care delivery with the widespread transition to virtual care without demanding preconditions. Caregivers' satisfaction is a critical parameter to ensuring the quality of clinical service in the pediatric population. Despite this fact, such patient-related factors are under-investigated and poorly documented in developing countries such as Ethiopia. The study was aimed to assess caregivers' satisfaction regarding teleconsultations and associated factors during COVID-19 pandemic at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Methods Health institution-based cross-sectional survey was conducted in randomly selected caregivers who were served with phone-based medical consultations during the pandemic. Data were collected by means of a pretested, structured interviewer-administered questionnaire. Data were entered into Excel 2016 and analyzed using SPSS version 26. Logistic regression models were used to predict the association of study variables and adjusted for possible confounders. Results Overall, 177 (61.5%) of participants reported satisfaction with the teleconsultation. Female caregivers (AOR=1.78; 95% CI 1.05, 3.01), having family support (AOR=2.6; 95% CI 1.45, 4.65), access to a nearby laboratory (AOR=2.18; 95% CI 1.24, 3.83), having access to nearby pharmacy (AOR=2.82; 95% CI 1.63, 4.86) were found to be predictors of caregivers' satisfaction with teleconsultation in the study area. Conclusion A considerable number of caregivers were satisfied with the teleconsultation service during the COVID-19 pandemic. It is important for healthcare providers and policy makers to strengthen the provision of teleconsultation service options for caregivers including women and those with better access to diagnostic centers and pharmacies. They should try to make teleconsultation caregiver-friendly.
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Affiliation(s)
- Ahmed Ketema Abegaz
- Department of Pediatrics and Child Health, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebe Habtamu Tamire
- Department of Pediatrics and Child Health, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Hussen Asfaw
- Department of Nursing, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
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Antoun J, Saab B, Usta J, Romani M, Akl IB, El Mofti MF, Eter J, AlArab N, Itani H. Development of an assessment tool to measure communication skills among family medicine residents in the context of electronic medical record use. BMC MEDICAL EDUCATION 2023; 23:245. [PMID: 37060046 PMCID: PMC10103454 DOI: 10.1186/s12909-023-04216-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 03/31/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND The introduction of the electronic medical record (EMR) has led to new communication skills that need to be taught and assessed. There is scarce literature on validated instruments measuring electronic-specific communication skills. The aim is to develop an assessment checklist that assesses the general and EMR-specific communication skills and evaluates their content validity and reliability. METHODS Using the SEGUE theoretical framework for communication skills, the assessment checklist items were developed by the Communication Skills Working Group (CSWG) at the family medicine department using a literature review about the positive and negative aspects of EMR use on physician-patient communication. A group of faculty members rated real resident-patient encounters on two occasions, three weeks apart. Patients were asked to fill out the Communication Assessment Tool (CAT) at the end of the encounter. RESULTS A total of 8 residents agreed to participate in the research, with 21 clinical encounters recorded. The average total score was 65.2 ± 6.9 and 48.1 ± 9.5 for the developed scale and the CAT scale, respectively. The scale reliability was good, with a Cronbach alpha of 0.694. The test-retest reliability was 0.873, p < 0.0001. For the total score on the developed checklist, the intraclass correlation coefficient between raters (ICC) was 0.429 [0.030,0.665], p-value of 0.019. The level of agreement between any two raters on the cumulative score of the 5 subsections ranged from 0.506 (interpersonal skills) to 0.969 (end encounter). CONCLUSION This checklist is a reliable and valid instrument that combines basic and EMR-related communication skills.
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Affiliation(s)
- Jumana Antoun
- Department of Family Medicine, American University of Beirut, Lebanon, Lebanon.
| | - Bassem Saab
- Department of Family Medicine, American University of Beirut, Lebanon, Lebanon
| | - Jinan Usta
- Department of Family Medicine, American University of Beirut, Lebanon, Lebanon
| | - Maya Romani
- Department of Family Medicine, American University of Beirut, Lebanon, Lebanon
| | - Imad Bou Akl
- Department of Internal Medicine, American University of Beirut, Lebanon, Lebanon
| | | | - Joudy Eter
- Department of Family Medicine, American University of Beirut, Lebanon, Lebanon
| | - Natally AlArab
- Department of Family Medicine, American University of Beirut, Lebanon, Lebanon
| | - Hala Itani
- Department of Family Medicine, American University of Beirut, Lebanon, Lebanon
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Tan HJ, Chung AE, Gotz D, Deal AM, Heiling HM, Teal R, Vu MB, Meeks WD, Fang R, Bennett AV, Nielsen ME, Basch E. Electronic Health Record Use and Perceptions among Urologic Surgeons. Appl Clin Inform 2023; 14:279-289. [PMID: 37044288 PMCID: PMC10097476 DOI: 10.1055/s-0043-1763513] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/19/2023] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVE Electronic health records (EHRs) have become widely adopted with increasing emphasis on improving care delivery. Improvements in surgery may be limited by specialty-specific issues that impact EHR usability and engagement. Accordingly, we examined EHR use and perceptions in urology, a diverse surgical specialty. METHODS We conducted a national, sequential explanatory mixed methods study. Through the 2019 American Urological Association Census, we surveyed urologic surgeons on EHR use and perceptions and then identified associated characteristics through bivariable and multivariable analyses. Using purposeful sampling, we interviewed 25 urologists and applied coding-based thematic analysis, which was then integrated with survey findings. RESULTS Among 2,159 practicing urologic surgeons, 2,081 (96.4%) reported using an EHR. In the weighted sample (n = 12,366), over 90% used the EHR for charting, viewing results, and order entry with most using information exchange functions (59.0-79.6%). In contrast, only 35.8% felt the EHR increases clinical efficiency, whereas 43.1% agreed it improves patient care, which related thematically to information management, administrative burden, patient safety, and patient-surgeon interaction. Quantitatively and qualitatively, use and perceptions differed by years in practice and practice type with more use and better perceptions among more recent entrants into the urologic workforce and those in academic/multispecialty practices, who may have earlier EHR exposure, better infrastructure, and more support. CONCLUSION Despite wide and substantive usage, EHRs engender mixed feelings, especially among longer-practicing surgeons and those in lower-resourced settings (e.g., smaller and private practices). Beyond reducing administrative burden and simplifying information management, efforts to improve care delivery through the EHR should focus on surgeon engagement, particularly in the community, to boost implementation and user experience.
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Affiliation(s)
- Hung-Jui Tan
- Department of Urology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Arlene E. Chung
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, United States
| | - David Gotz
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
- School of Information and Library Science, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Allison M. Deal
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Hillary M. Heiling
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Randall Teal
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
- Connected Health Applications and Interventions Core, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Maihan B. Vu
- Connected Health Applications and Interventions Core, University of North Carolina, Chapel Hill, North Carolina, United States
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, North Carolina, United States
| | - William D. Meeks
- Data Management and Statistical Analysis, American Urological Association, Linthicum, Maryland, United States
| | - Raymond Fang
- Data Management and Statistical Analysis, American Urological Association, Linthicum, Maryland, United States
| | - Antonia V. Bennett
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Matthew E. Nielsen
- Department of Urology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Ethan Basch
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States
- Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
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Kumi R, Reychav I, Azuri J, Sabherwal R. Tablet in the Consultation Room and Physician Satisfaction. INTERNATIONAL JOURNAL OF HEALTHCARE INFORMATION SYSTEMS AND INFORMATICS 2023. [DOI: 10.4018/ijhisi.318445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
The purpose of the study is to investigate patient-physician interactions during a clinical encounter to ascertain the impact of tablet computing on physician satisfaction during a clinical encounter. This study was conducted at a primary care clinic, and the physicians who participated could use a tablet during their clinical encounters. The authors compared satisfaction between physicians who used the tablet during a clinical encounter and those who did not using data from 122 clinical encounters involving 82 patients. The results indicate that physicians who used the tablet during clinical encounters are more satisfied than those who did not. Additionally, there was a meaning difference in satisfaction between physicians who used the tablet to educate patients and share information than those who did not. HITs have potential benefits, but they also come with risks. To effectively manage the risks and benefits of HITs, healthcare providers should be deliberate and strategic in the implementation of HITs.
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Affiliation(s)
| | | | - Joseph Azuri
- Sackler Faculty of Medicine, Tel Aviv University, Israel
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Mavragani A, Chen Y, Yang H, Tao R, Chen X, Yu J. Investigation and Countermeasures Research of Hospital Information Construction of Tertiary Class-A Public Hospitals in China: Questionnaire Study. JMIR Form Res 2023; 7:e41820. [PMID: 36662565 PMCID: PMC9898827 DOI: 10.2196/41820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/03/2022] [Accepted: 01/05/2023] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Medical informatization has initially demonstrated its advantages in improving the medical service industry. Over the past decade, the Chinese government have made a lot of effort to complete infrastructural information construction in the medical and health domain, and smart hospitals will be the next priority according to policies released by Chinese government in recent years. OBJECTIVE To provide strategic support for further development of medical information construction in China, this study aimed to investigate the current situation of medical information construction in tertiary class-A public hospitals and analyze the existing problems and countermeasures. METHODS This study surveyed 23 tertiary class-A public hospitals in China who voluntarily responded to a self-designed questionnaire distributed in April 2020 to investigate the current medical information construction status. Descriptive statistics were used to summarize the current configurations of hospital information department, hospital information systems, hospital internet service and its application, and the satisfaction of hospital information construction. Interviews were also conducted with the respondents in this study for requirement analysis. RESULTS The results show that hospital information construction has become one of the priorities of the hospitals' daily work, and the medical information infrastructural construction and internet service application of the hospitals are good; however, a remarkable gap among the different level of hospitals can be observed. Although most hospitals had built their own IT team to undertake information construction work, the actual utilization rate of big data collected and stored in the hospital information system was not satisfactory. CONCLUSIONS Support for the construction of information technology in primary care institutions should be increased to balance the level of development of medical informatization in medical institutions at all levels. The training of complex talents with both IT and medical backgrounds should be emphasized, and specialized disease information standards should be developed to lay a solid data foundation for data utilization and improve the utilization of medical big data.
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Affiliation(s)
| | - Yueyue Chen
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Hepato-Pancreatic-Biliary Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huiyuan Yang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Hepato-Pancreatic-Biliary Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ran Tao
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Hepato-Pancreatic-Biliary Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoping Chen
- Department of Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Hepato-Pancreatic-Biliary Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jingjing Yu
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Hepato-Pancreatic-Biliary Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Conroy M, Powell M, Suelzer E, Pamulapati S, Min H, Wright T, Kamaraju S. Electronic Medical Record-Based Electronic Messaging Among Patients with Breast Cancer: A Systematic Review. Appl Clin Inform 2023; 14:134-143. [PMID: 36581054 PMCID: PMC9931493 DOI: 10.1055/a-2004-6669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Electronic medical record (EMR) systems and electronic messages are an increasingly common conduit between physicians and patients. Clear benefits of this type of communication have been established, especially among cancer patients. Studies suggest that patient portals and electronic messaging platforms can help with care coordination between oncology providers and facilitate asynchronous patient-provider communication. Despite the many benefits, there is little research regarding EMR and secure messaging use, particularly among patients with breast cancer. OBJECTIVES The objective of this systematic review was to examine the evidence supporting the use of EMR-based messaging systems in patients with breast cancer. METHODS A systematic literature search of Ovid MEDLINE, PubMed, Scopus, Web of Science CINAHL, and Cochrane Library was conducted. Studies were required to be published between 2005 and 2022 and report data on demographic information and electronic messaging between patients and providers. Studies were excluded if they reported insufficient data, did not include breast cancer patients, or were not published in English. RESULTS This study identified 10 articles that met inclusion criteria. The resulting studies investigated topics such as: patterns of messaging and medication adherence, cancer screening, messaging as a predictor of behavior or outcomes, and symptom management. The literature indicates that electronic messaging with providers was associated with clinical benefits for breast cancer patients and improved screening behaviors. CONCLUSION This review uncovered multiple areas to focus future research on, including ideal volume of electronic messages sent and their relation to prescription adherence, studies focusing solely on the breast cancer population, racial disparities in electronic messaging, and provider perceptions of electronic messaging. It is vital that more work be done to understand barriers and gaps in EMR usage to ensure that all individuals can access this increasingly essential medical service while minimizing physician workload and burnout.
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Affiliation(s)
- Meghan Conroy
- Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Miracle Powell
- Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | | | | | - Heun Min
- Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Tamiah Wright
- Froedtert Hospital, Milwaukee, Wisconsin, United States
| | - Sailaja Kamaraju
- Medical College of Wisconsin, Milwaukee, Wisconsin, United States
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Del Grande C, Kaczorowski J, Pomey MP. What are the top priorities of patients and clinicians for the organization of primary cardiovascular care in Quebec? A modified e-Delphi study. PLoS One 2023; 18:e0280051. [PMID: 36598919 DOI: 10.1371/journal.pone.0280051] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 12/20/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Cardiovascular diseases are the leading cause of death and disability worldwide. Little is known about the organizational priorities of patients and clinicians involved in primary cardiovascular care. This study aimed to identify their shared top priorities and explore on which aspects their perspectives differed. METHODS A three-round modified online Delphi study was carried out with patients and clinicians in seven academic primary care settings from metropolitan, suburban and small-town areas in Quebec, Canada. Patient partners experienced in the mobilization of their experiential knowledge also participated in the study. Following an "open" round, the items elicited were assessed by a combined rating and ranking approach. Items achieving an initial consensus level ≥70% were reassessed and then rank-ordered based on their final scores. Levels of consensus achieved among patients and clinicians were compared using Fisher's Exact tests. RESULTS Thirty panelists completed the study (9 clinic patients, 7 patient partners and 14 clinicians). Out of 41 organizational aspects generated, six top priorities were shared by patients and clinicians. These related to listening and tailoring care to each patient, provision of personalized information, rapid response in the event of a problem, keeping professional training up-to-date, and relational and informational continuity of care. Statistically significant differences were found between patients' and clinicians' perspectives regarding the importance of offering healthy lifestyle and prevention activities at the clinic (lower for patients), timely access to the treating physician (higher for patients), and effective collaboration with specialist physicians (higher for patients). CONCLUSION Although their views differ on some organizational aspects, patients and clinicians share a small set of top priorities for primary cardiovascular care that may be transferable to other chronic diseases. These top priorities should remain a central focus of clinical settings, alongside other primary care reform goals.
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Affiliation(s)
- Claudio Del Grande
- Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
- School of Public Health, Université de Montréal, Montreal, Quebec, Canada
| | - Janusz Kaczorowski
- Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Marie-Pascale Pomey
- Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
- School of Public Health, Université de Montréal, Montreal, Quebec, Canada
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Cilović-Lagarija Š, Musa S, Stojisavljević S, Hasanica N, Kuduzović E, Palo M, Majdan M, Scherzer M, Habersaat KB, Smallwood C, Tahirukaj A, Nitzan D. Satisfaction with Health Care Services in the Adult Population of the Federation of Bosnia and Herzegovina during the COVID-19 Pandemic. MEDICINA (KAUNAS, LITHUANIA) 2022; 59:medicina59010097. [PMID: 36676723 PMCID: PMC9867260 DOI: 10.3390/medicina59010097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 12/25/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023]
Abstract
Background and Objectives: Patient satisfaction with health care can influence health care-seeking behavior in relation to both minor or major health problems or influence communication and compliance with medical advice, which is especially important in emergencies such as the COVID-19 pandemic. Thus, it is important to continually monitor patient satisfaction with provided care and their dynamics. The aim of this study was to assess patient satisfaction with health care during the COVID-19 pandemic in the adult population of the Federation of Bosnia and Herzegovina (FB&H) and compare it with levels of satisfaction in the same population before the COVID-19 pandemic. Materials and Methods: A representative, population-based survey was implemented in the adult population of the FB&H using the EUROPEP instrument, which measures satisfaction with health care using 23 items. The sample included 740 respondents who were 18 years or older residing in the FB&H and was implemented in December 2020. All data were collected using a system of online panels. The survey questions targeted the nine months from the beginning of the pandemic to the time of data collection, i.e., the period of March to December 2020. Results: The mean composite satisfaction score across all 23 items of the EUROPEP tool was 3.2 points in all age groups; the ceiling effect was 22% for the youngest respondents (18-34 years old), 23% for 35-54 years old, and 26% for the oldest group (55+), showing increasing satisfaction by age. The overall composite score for both females and males was 3.2. The ceiling effect was higher in those with chronic disease (29% vs. 23% in those without chronic disease). The composite mean score for respondents residing in rural vs. urban areas was 3.2 with a ceiling effect of 22% in rural and 24% in urban residents. When comparing mean composite scores surveyed at various points in time in the FB&H, it was found that the score increased from 3.3 to 3.5 between 2011 and 2017 and dropped again to 3.3 in this study. Despite these observations in the overall trends of satisfaction scores, we note that no statistically significant differences were observed between most of the single-item scores in the stratified analysis, pointing to the relative uniformity of satisfaction among the analyzed population subgroups. Conclusions: The rate of satisfaction with health care services in the FB&H was lower during the COVID-19 pandemic compared to 2011 and 2017. Furthermore, while an increasing trend in satisfaction with health care was observed in the FB&H during the years prior to 2020, the COVID-19 pandemic may have contributed to the reversal of this trend. It is important to further monitor the dynamics of patient satisfaction with health care, which could serve as a basis for planning, delivering, and maintaining quality services during the COVID-19 pandemic and other emergencies.
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Affiliation(s)
- Šeila Cilović-Lagarija
- Department of Statistic, Institute for Public Health FB&H, 71000 Sarajevo, Bosnia and Herzegovina
| | - Sanjin Musa
- Department of Epidemiology, Institute for Public Health FB&H, 71000 Sarajevo, Bosnia and Herzegovina
| | - Stela Stojisavljević
- Department of Social Medicine, Public Health Institute of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
- Medical Faculty, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Nino Hasanica
- Medical Faculty, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Elma Kuduzović
- Institute for Health and Food Safety Zenica, Institute for Public Health, 72000 Zenica, Bosnia and Herzegovina
| | - Mirza Palo
- Country Office in Bosnia and Herzegovina, World Health Organization, 71000 Sarajevo, Bosnia and Herzegovina
| | - Marek Majdan
- Health Emergencies Programme, World Health Organization Regional Office for Europe, 2100 Copenhagen, Denmark
- Institute for Global Health and Epidemiology, Faculty of Health Sciences and Social Work, Trnava University, Hornopotocna 23, 91843 Trnava, Slovakia
- Correspondence: ; Tel.: +42-19-1188-1125
| | - Martha Scherzer
- Country Health Programmes, World Health Organization Regional Office for Europe, 2100 Copenhagen, Denmark
| | - Katrine Bach Habersaat
- Country Health Programmes, World Health Organization Regional Office for Europe, 2100 Copenhagen, Denmark
| | - Catherine Smallwood
- Health Emergencies Programme, World Health Organization Regional Office for Europe, 2100 Copenhagen, Denmark
| | - Ardita Tahirukaj
- Health Emergencies Programme, World Health Organization Regional Office for Europe, 2100 Copenhagen, Denmark
| | - Dorit Nitzan
- Health Emergencies Programme, World Health Organization Regional Office for Europe, 2100 Copenhagen, Denmark
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Ibrahim AA, Ahmad Zamzuri M‘AI, Ismail R, Ariffin AH, Ismail A, Muhamad Hasani MH, Abdul Manaf MR. The role of electronic medical records in improving health care quality: A quasi-experimental study. Medicine (Baltimore) 2022; 101:e29627. [PMID: 35905245 PMCID: PMC9333510 DOI: 10.1097/md.0000000000029627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The Teleprimary Care-Oral Health Clinical Information System (TPC-OHCIS) is an updated electronic medical record (EMR) that has been applied in Malaysian primary healthcare. Recognizing the level of patient satisfaction following EMR implementation is crucial for assessing the performance of health care services. Hence, the main objective of this study was to compare the level of patient satisfaction between EMR-based clinics and paper-based clinics. The study was a quasi-experimental design that used a control group and was conducted among patients in 14 public primary healthcare facilities in the Seremban district of Malaysia from May 10, to June 30, 2021. Patient satisfaction was assessed using the validated Short-Form Patient Satisfaction Questionnaire, which consisted of 7 subscales. All data were analyzed using the IBM Statistical Package for Social Sciences version 21. A total of 321 patients consented to participate in this study, and 48.9% of them were from EMR clinics. The mean score for the communication subscale was the highest at 4.08 and 3.96 at EMR-adopted clinics and paper-based record clinics. There were significant differences in general satisfaction and communication subscales, with higher patient satisfaction found in clinics using EMR. With the utilization of EMR, patient satisfaction and communication in delivering healthcare services have improved.
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Affiliation(s)
- Ariff Azfarahim Ibrahim
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Fakulti Perubatan UKM, Cheras, Kuala Lumpur, Malaysia
| | - Mohd ‘Ammar Ihsan Ahmad Zamzuri
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Fakulti Perubatan UKM, Cheras, Kuala Lumpur, Malaysia
| | - Rosnah Ismail
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Fakulti Perubatan UKM, Cheras, Kuala Lumpur, Malaysia
| | - Ahmad Husni Ariffin
- Family Health Development Division, Seremban District Health Office, Ministry of Health, Seremban, Negeri Sembilan, Malaysia
| | - Aniza Ismail
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Fakulti Perubatan UKM, Cheras, Kuala Lumpur, Malaysia
| | - Muhamad Hazizi Muhamad Hasani
- Family Health Development Division, Seremban District Health Office, Ministry of Health, Seremban, Negeri Sembilan, Malaysia
| | - Mohd Rizal Abdul Manaf
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Fakulti Perubatan UKM, Cheras, Kuala Lumpur, Malaysia
- *Correspondence: Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, 6th Floor, Blok Praklinikal, Fakulti Perubatan UKM, Cheras, Kuala Lumpur 56000, Malaysia (e-mail: )
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Tranter I, van Driel ML, Mitchell B. Doctor! Did you Google my symptoms? A qualitative study of patient perceptions of doctors' point-of-care information seeking. BMJ Open 2022; 12:e061090. [PMID: 35896298 PMCID: PMC9335025 DOI: 10.1136/bmjopen-2022-061090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To explore patient perceptions regarding doctors' information seeking during consultations. DESIGN AND SETTING Qualitative interviews with participants from six general practice waiting rooms in South East Queensland, Australia. Participants were asked about their experiences and opinions, and to comment on short videos of simulated consultations in which a doctor sought information. The interviews were analysed through a process of iterative thematic analysis using the framework of Braun and Clarke. PARTICIPANTS The 16 participants were purposively sampled including 5 men and 11 women from a diverse range of educational and age groups. RESULTS How a doctor's need to look up information impacted patient impressions of competence and trust was an overarching theme. The four dominant themes include: the trust a patient has in the doctor before the consultation, whether the doctor is expected to know the answer to a question without searching, has the doctor added value to the consultation by searching and the consultation skills used in the process. CONCLUSIONS Patient trust is fundamental to positive perceptions of general practitioners' information seeking at the point-of-care. Communication is key to building this trust. Understanding the patient's agenda, listening, assessing thoroughly and being honest and transparent about the need to seek information all contribute to a positive experience.
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Affiliation(s)
- Isaac Tranter
- General Practice Clinical Unit, The University of Queensland Faculty of Medicine and Biomedical Sciences, Herston, Queensland, Australia
| | - Mieke L van Driel
- General Practice Clinical Unit, The University of Queensland Faculty of Medicine and Biomedical Sciences, Herston, Queensland, Australia
| | - Ben Mitchell
- General Practice Clinical Unit, The University of Queensland Faculty of Medicine and Biomedical Sciences, Herston, Queensland, Australia
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Jongerius C, Hillen MA, Romijn JA, Smets EMA, Koole T. Physician gaze shifts in patient-physician interactions: functions, accounts and responses. PATIENT EDUCATION AND COUNSELING 2022; 105:2116-2129. [PMID: 35287994 DOI: 10.1016/j.pec.2022.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 02/27/2022] [Accepted: 02/28/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Physician gaze towards patients is fundamental for medical consultations. Physicians' use of Electronic Health Records (EHR) affects their gaze towards patients, and may negatively influence this interaction. We aimed to study conversation patterns during gaze shifts of physicians from the patient towards the EHR. METHODS Outpatient consultations (N = 8) were eye-tracked. Interactions around physician gaze shifts towards the computer were transcribed. RESULTS We found that physician gaze shifts have different interactional functions, e.g., introducing a topic switch or entering data into the EHR. Furthermore, physicians differ in how they account for their gaze shifts, i.e., both implicitly and explicitly. Third, patients vary in treating the gaze shift as an indication to continue their turn or not. CONCLUSIONS Our results suggest that physician gaze shifts vary in function, in how physicians account for them, and in how they influence the conversation. Future research should take into account distinctions when relating gaze to patient outcomes. PRACTICE IMPLICATIONS Physicians may be aware of the interactional context of their gaze behaviour. Patients respond differently to various types of gaze shifts. How physicians handle gaze shifts can therefore have different consequences for the interaction.
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Affiliation(s)
- Chiara Jongerius
- Amsterdam UMC, University of Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands.
| | - Marij A Hillen
- Amsterdam UMC, University of Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands
| | - Johannes A Romijn
- Amsterdam UMC, University of Amsterdam, Department of Medicine, Amsterdam, The Netherlands
| | - Ellen M A Smets
- Amsterdam UMC, University of Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands
| | - Tom Koole
- Centre for Language and Cognition (CLCG), University of Groningen, Groningen, The Netherlands; School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
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Meltzer EC, Vorseth KS, Croghan IT, Chang YHH, Mead-Harvey C, Johnston LA, Strader RD, Yost KJ, Marks LA, Poole KG. Use of the Electronic Health Record During Clinical Encounters: An Experience Survey. Ann Fam Med 2022; 20:312-318. [PMID: 35879072 PMCID: PMC9328709 DOI: 10.1370/afm.2826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/09/2021] [Accepted: 01/03/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Use of the electronic health record (EHR) during face-to-face clinical encounters affects communication, and prior research has been inconclusive regarding its effect. This survey study assessed health care practitioner use of EHR-specific communication skills and patient and practitioner experiences and attitudes regarding EHR use during clinical encounters. METHODS For this US-based study, we distributed previously validated surveys to practitioners and adult patients (aged >18 years) at academic primary care practices from July 1, 2018 through August 31, 2018. The electronic practitioner survey was completed first; a paper survey was administered to patients after appointments. Descriptive statistics were calculated, and the Cochran-Armitage test was used to assess for associations between key variables. RESULTS The practitioner response was 72.9% (43/59); patient response, 45.2% (452/1,000). Practitioners reported maintaining less eye contact (79.1%), listening less carefully (53.5%), focusing less on patients (65.1%), and visits feeling less personal (62.8%). However, patients reported that practitioners provided sufficient eye contact (96.8%) and listened carefully (97.0%); they disagreed that practitioners focused less on them (86.7%) or that visits felt less personal (87.2%). Patients thought EHR use was positive (91.7%); only one-third of practitioners (37.2%) thought that patients would agree with that statement. Practitioners reported stress, burnout, and a lack of sufficient time for EHR documentation. CONCLUSIONS A discrepancy existed in this study between patient and practitioner experiences and attitudes about EHR use, which appeared to negatively affect the experience of health care practitioners but not patients. Organizations should adopt formal strategies to improve practitioner experiences with EHR use.
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Affiliation(s)
- Ellen C Meltzer
- Division of General Internal Medicine, Mayo Clinic, Scottsdale, Arizona .,Office of Patient Experience, Mayo Clinic, Phoenix, Arizona
| | - Kelly S Vorseth
- Office of Patient Experience, Mayo Clinic, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Ivana T Croghan
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Yu-Hui H Chang
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Scottsdale, Arizona
| | - Carolyn Mead-Harvey
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Scottsdale, Arizona
| | | | | | - Kathleen J Yost
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Lisa A Marks
- Library Services, Mayo Clinic, Scottsdale, Arizona
| | - Kenneth G Poole
- Office of Patient Experience, Mayo Clinic, Phoenix, Arizona.,Division of Community Internal Medicine, Mayo Clinic, Scottsdale, Arizona
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Palomares V, Patel A, Wagner E, McCarthy E, Adams W, Fitz M. The implementation of scribing within a medical school's pre-clinical curriculum: pilot study. BMC MEDICAL EDUCATION 2022; 22:315. [PMID: 35468791 PMCID: PMC9040319 DOI: 10.1186/s12909-022-03379-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 02/28/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Medical students matriculating from their preclinical curriculum into clinical clerkships face a significant learning curve when using an electronic medical record (EMR) system for clinical documentation. With the trend toward reduction in preclinical medical education, students now have fewer opportunities to optimize their note-writing and overall clinical skills before transitioning to patient-care settings. METHODS This study sought to investigate how a structured medical scribing program in an outpatient clinic helps bridge the gap between traditional preclinical and clinical curricula in medical education. A small cohort of medical students were trained in medical scribing within our institutions' existing preclinical preceptorship program. We surveyed students, preceptors, and patients during the project to better understand confidence around documentation, the EMR, and the impact of the scribing program on workflow efficiency and patient satisfaction. RESULTS There was no significant difference between the scribe and non- scribe students in their confidence documenting a patient encounter or navigating EMR (all p > .05). Our study demonstrated that preceptors for scribe students reported a significant decrease in documentation time compared to non-scribes (Mdiff = - 5.75, p = .02), with no negative impact on patient satisfaction. CONCLUSIONS Medical scribing can be a tool to further develop medical trainees in clinical documentation and help prepare them for the responsibilities during clinical years. When summing the per encounter time savings over the course of a half or full clinic day, scribing can return a significant amount of time back to preceptors. The time saved by the preceptor needs to be further investigated to determine if the time can lend itself towards better patient care, student-specific feedback, focused teaching, or even mentoring.
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Affiliation(s)
- Vanessa Palomares
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Arpan Patel
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Ellen Wagner
- Department of Pediatrics, University of Chicago, Chicago, IL, USA
| | - Elisa McCarthy
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - William Adams
- Department of Medical Education, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Matthew Fitz
- Department of Internal Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA.
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Yang R, Zeng K, Jiang Y. Prevalence, Factors, and Association of Electronic Communication Use With Patient-Perceived Quality of Care From the 2019 Health Information National Trends Survey 5-Cycle 3: Exploratory Study. J Med Internet Res 2022; 24:e27167. [PMID: 35119369 PMCID: PMC8857700 DOI: 10.2196/27167] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 06/25/2021] [Accepted: 11/10/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Electronic communication (e-communication), referring to communication through electronic platforms such as the web, patient portal, or mobile phone, has become increasingly important, as it extends traditional in-person communication with fewer limitations of timing and locations. However, little is known about the current status of patients' use of e-communication with clinicians and whether the use is related to the better patient-perceived quality of care at the population level. OBJECTIVE The aim of this study was to explore the prevalence of and the factors associated with e-communication use and the association of e-communication use with patient-perceived quality of care by using the nationally representative sample of the 2019 Health Information National Trends Survey 5 (HINTS 5)-Cycle 3. METHODS Data from 5438 adult responders (mean age 49.04 years, range 18-98 years) were included in this analysis. Multiple logistic and linear regressions were conducted to explore responders' personal characteristics related to their use of e-communication with clinicians in the past 12 months and how their use was related to perceived quality of care. Descriptive analyses for e-communication use according to age groups were also performed. All analyses considered the complex survey design using the jackknife replication method. RESULTS The overall prevalence of e-communication use was 60.3%, with a significantly lower prevalence in older adults (16.6%) than that in <45-year-old adults (41%) and 45-65-year-old adults (42.4%). All percentages are weighted; therefore, absolute values are not shown. American adults who used e-communication were more likely to be high school graduates (odds ratio [OR] 1.95, 95% CI 1.14-3.34; P=.02), some college degree holders (OR 3.34, 95% CI 1.84-6.05; P<.001), and college graduates or more (OR 4.89, 95% CI 2.67-8.95; P<.001). Further, people who were females (OR 1.47, 95% CI 1.18-1.82; P=.001), with a household income ≥US $50,000 (OR 1.63, 95% CI 1.23-2.16; P=.001), with more comorbidities (OR 1.22, 95% CI 1.07-1.40; P=.004), or having a regular health care provider (OR 2.62, 95% CI 1.98-3.47; P<.001), were more likely to use e-communication. In contrast, those who resided in rural areas (OR 0.61, 95% CI 0.43-0.88; P=.009) were less likely to use e-communication. After controlling for the sociodemographics, the number of comorbidities, and relationship factors (ie, having a regular provider and trusting a doctor), e-communication use was found to be significantly associated with better perceived quality of care (β=.12, 95% CI 0.02-0.22; P=.02). CONCLUSIONS This study confirmed the positive association between e-communication use and patient-perceived quality of care and suggested that policy-level attention should be raised to engage the socially disadvantaged (ie, those with lower levels of education and income, without a regular health care provider, and living in rural areas) to maximize e-communication use and to support better patient-perceived quality of care among American adults.
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Affiliation(s)
- Rumei Yang
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Kai Zeng
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Yun Jiang
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
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Kernebeck S, Busse TS, Jux C, Bork U, Ehlers JP. Electronic Medical Records for (Visceral) Medicine: An Overview of the Current Status and Prospects. Visc Med 2022; 37:476-481. [PMID: 35087897 DOI: 10.1159/000519254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/24/2021] [Indexed: 11/19/2022] Open
Abstract
Background Electronic medical records (EMRs) offer key advantages over analog documentation in healthcare. In addition to providing details about current and past treatments, EMRs enable clear and traceable documentation regardless of the location. This supports evidence-based, multi-professional treatment and leads to more efficient healthcare. However, there are still several challenges regarding the use of EMRs. Understanding these challenges is essential to improve healthcare. The aim of this article is to provide an overview of the current state of EMRs in the field of visceral medicine, to describe the future prospects in this field, and to highlight some of the challenges that need to be faced. Summary The benefits of EMRs are manifold and particularly pronounced in the area of quality assurance and improvement of communication not only between different healthcare professionals but also between physicians and patients. Besides the danger of medical errors, the health consequences for the users (cognitive load) arise from poor usability or a system that does not fit into the real world. Involving users in the development of EMRs in the sense of participatory design can be helpful here. The use of EMRs in practice together with patients should be accompanied by training to ensure optimal outcomes in terms of shared decision-making. Key Message EMRs offer a variety of benefits. However, it is critical to consider user involvement, setting specificity, and user training during development, implementation, and use in order to minimize unintended consequences.
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Affiliation(s)
- Sven Kernebeck
- Chair of Didactics and Educational Research in Health Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Theresa Sophie Busse
- Chair of Didactics and Educational Research in Health Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Chantal Jux
- Chair of Didactics and Educational Research in Health Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Ulrich Bork
- Department of Gastrointestinal-, Thoracic- and Vascular Surgery, Dresden Technical University, University Hospital Dresden, Dresden, Germany
| | - Jan P Ehlers
- Chair of Didactics and Educational Research in Health Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
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Abstract
BACKGROUND AND OBJECTIVES Health care organizations track patient experience data, identify areas of improvement, monitor provider performance, and assist providers in improving their interactions with patients. Some practices use one-on-one provider counseling ("shadow coaching") to identify and modify provider behaviors. A recent evaluation of a large shadow coaching program found statistically significant improvements in coached providers' patient experience scores immediately after being coached. This study aimed to examine the content of the recommendations given to those providers aimed at improving provider-patient interactions, characterize these recommendations, and examine their actionability. METHODS Providers at a large, urban federally qualified health center were selected for coaching based on Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) patient experience scores (92 of 320 providers), shadowed by a trained peer coach for a half to full day and received recommendations on how to improve interactions with their patients. We coded 1082 recommendations found in the 92 coaching reports. RESULTS Reports contained an average of 12 recommendations. About half encouraged consistency of existing behaviors and half encouraged new behaviors. Most recommendations related to behaviors of the provider rather than support staff and targeted actions within the examination room rather than other spaces (eg, waiting room). The most common recommendations mapped to behavioral aspects of provider communication. Most recommendations targeted verbal rather than nonverbal communication behaviors. Most recommendations were actionable (ie, specific, descriptive), with recommendations that encouraged new behaviors being more actionable than those that encouraged existing actions. CONCLUSIONS Patient experience surveys are effective at identifying where improvement is needed but are not always informative enough to instruct providers on how to modify and improve their interactions with patients. Analyzing the feedback given to coached providers as part of an effective shadow-coaching program provides details about implementation on shadow-coaching feedback. Recommendations to providers aimed at improving their interactions with patients need to not only suggest the exact behaviors defined within patient experience survey items but also include recommended behaviors indirectly associated with those measured behaviors. Attention needs to be paid to supplementing patient experience data with explicit, tangible, and descriptive (ie, actionable) recommendations associated with the targeted, measured behaviors. Research is needed to understand how recommendations are put into practice by providers and what motivates and supports them to sustain changed behaviors.
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Zheng H, Jiang S. Frequent and diverse use of electronic health records in the United States: A trend analysis of national surveys. Digit Health 2022; 8:20552076221112840. [PMID: 35832476 PMCID: PMC9272053 DOI: 10.1177/20552076221112840] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/23/2022] [Indexed: 11/15/2022] Open
Abstract
Objective Considering the increasing integration of electronic health records (EHRs) into medical practice by healthcare organizations, it is especially pertinent to understand its actual usage by the general public in recent years. This study aims to explore factors associated with the frequency and diversity of EHR usage in the United States over time. Methods We analyzed three iterations (2017, 2018, and 2019) of the Health Information National Trends Survey (HINTS). HINTS is a national cross-sectional survey conducted by the National Cancer Institute to document attitudes and perceptions about health information access and use among American adults. Results Both frequency and diversity of EHR usage have slightly increased across the years. However, its overall usage still remained low. Three technology-related enablers (access to digital devices, access to the Internet, and perceived usefulness of EHRs) were positively related to EHR usage in all three iterations. In addition, perceived health status was a constant and negative predictor of EHR usage over years. Doctor–patient communication was positively associated with the frequency of EHR usage in two survey waves. Conclusions More initiatives to increase EHR usage in the United States are needed. We advocate for providing affordable Internet access and smartphone to underserved populations; in medical encounters, doctors should have more patient-centered communication, introduce the benefits of EHRs to patients, and promote EHR adoption in terms of frequency and diversity.
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Affiliation(s)
- Han Zheng
- School of Information Management, Wuhan University, China
- Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore
| | - Shaohai Jiang
- Department of Communications and New Media, National University of Singapore, Singapore
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Huhtakangas M, Tuomikoski AM, Laukka E, Kääriäinen M, Kanste O. Adult patients' experiences of patient-professional communication in patient portals: a qualitative systematic review protocol. JBI Evid Synth 2021; 20:689-695. [PMID: 34719661 PMCID: PMC8860204 DOI: 10.11124/jbies-21-00091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective: The objective of the review is to identify, critically appraise, and synthesize the best available evidence on adult patients’ experiences of patient-professional communication in patient portals. Introduction: Alongside face-to-face communication, patient portals can improve care quality and patients’ self-management of chronic diseases. It is important to examine how patients experience patient-professional communication in patient portals because this digital environment inherently lacks non-verbal messages, which can lead to misunderstandings. Inclusion criteria: Qualitative studies that describe patients’ experiences of reciprocal patient-professional communication in patient portals will be included. Patients must be over the age of 18 years and have a need for long-term care delivered by a health care professional (eg, patients with chronic diseases, such as cancer or diabetes). The health care professionals considered for inclusion are the members of the patient's health care team who communicate with the patient using patient portals. A patient portal is defined as a personal health record, which is either an independent webpage or interconnected with an electronic health record. Methods: The following databases will be searched: MEDLINE (PubMed), CINAHL (EBSCO), ProQuest (Abi/Inform), Scopus, Medic, Google Scholar, Science Direct and Cochrane CENTRAL. Gray literature will be searched in MedNar. Studies published in English, Finnish, or Swedish will be considered, and there is no date limitation. Studies will be screened and critically appraised for methodological quality by two independent researchers. Data will be extracted using a standardized tool from JBI SUMARI. Data synthesis will be conducted according to the meta-aggregation approach. Confidence in the evidence will be assessed using the ConQual approach. Systematic review registration number: PROSPERO CRD42021286177
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Affiliation(s)
- Moona Huhtakangas
- Department of Nursing Science and Health Management, University of Oulu, Oulu, Finland The Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Helsinki, Finland Oulu University of Applied Sciences, University of Oulu, Oulu, Finland Finnish Institute for Health and Welfare, Health and Social Service System Research Team, Helsinki, Finland
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Artificial Intelligence Algorithm with ICD Coding Technology Guided by the Embedded Electronic Medical Record System in Medical Record Information Management. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:3293457. [PMID: 34497706 PMCID: PMC8421187 DOI: 10.1155/2021/3293457] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/04/2021] [Accepted: 08/16/2021] [Indexed: 01/18/2023]
Abstract
The study aims to explore the application of international classification of diseases (ICD) coding technology and embedded electronic medical record (EMR) system. The study established an EMR information knowledge system and collected the data of patient medical records and disease diagnostic codes on the front pages of 8 clinical departments of endocrinology, oncology, obstetrics and gynecology, ophthalmology, orthopedics, neurosurgery, and cardiovascular medicine for statistical analysis. Natural language processing-bidirectional recurrent neural network (NLP-BIRNN) algorithm was used to optimize medical records. The results showed that the coder was not clear about the basic rules of main diagnosis selection and the classification of disease coding and did not code according to the main diagnosis principles. The disease was not coded according to different conditions or specific classification, the code of postoperative complications was inaccurate, the disease diagnosis was incomplete, and the code selection was too general. The solutions adopted were as follows: communication and knowledge training should be strengthened for coders and medical personnel. BIRNN was compared with the convolutional neural network (CNN) and recurrent neural network (RNN) in accuracy, symptom accuracy, and symptom recall, and it suggested that the proposed BIRNN has higher value. Pathological language reading under artificial intelligence algorithm provides some convenience for disease diagnosis and treatment.
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Langford AT, Orellana K, Buderer N. Use of Online Medical Records to Support Medical Decision Making: A Cross-Sectional Study of US Adults. JOURNAL OF HEALTH COMMUNICATION 2021; 26:618-625. [PMID: 34637375 DOI: 10.1080/10810730.2021.1983893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The use of online medical records has increased over time and may enhance patient involvement in medical decisions. We explored sociodemographic, medical condition, and digital health correlates of using online medical records to support medical decision making. Cross-sectional data from the 2019 Health Information National Trends Survey (HINTS 5, Cycle 3, N = 5438) were analyzed. Final analyses included participants who accessed their online medical records within 12 months and had complete data for all variables (n = 1807). The outcome was, "In the past 12 months have you used your online medical record to help you make a decision about how to treat an illness or condition (yes/no)?" Univariate and multivariate odds ratios and 95% confidence intervals were calculated. Multivariately, the odds of using online medical records to support medical decision making were significantly higher for individuals who (a) used online medical records to securely send messages to health care providers, (b) used a smartphone health app to access their online medical records, (c) had online medical records that contained clinical notes, (d) reported that online medical records were useful for monitoring health, and (e) self-identified as African American, Asian, or "Other." Online medical records may support medical decision making depending on the context.
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Affiliation(s)
| | - Kerli Orellana
- Population Health, NYU Langone Health, New York, New York, USA
| | - Nancy Buderer
- Nancy Buderer Consulting, LLC, Oak Harbor, Ohio, USA
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Karimi N, Kanazaki R, Lukin A, Moore AR, Williams AJ, Connor S. Clinical communication in inflammatory bowel disease: a systematic review of the study of clinician-patient dialogue to inform research and practice. BMJ Open 2021; 11:e051053. [PMID: 34452967 PMCID: PMC8404434 DOI: 10.1136/bmjopen-2021-051053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/13/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES This systematic review aims to investigate what is currently known about the characteristics of interactions between patients with inflammatory bowel disease (IBD) and their clinicians and its effect on patient outcomes. DATA SOURCES Scopus, PubMed, Embase, Communication Abstracts, Health & Society, Linguistics and Language Behaviour Abstracts and PsycINFO were systematically searched from inception to June 2021. STUDY ELIGIBILITY CRITERIA Peer-reviewed journal articles and book chapters in English investigating the characteristics of naturally occurring interactions between clinicians that manage IBD and patients with IBD during recorded consultations were included. STUDY APPRAISAL AND SYNTHESIS METHODS Risk of bias was assessed using a specifically developed quality assessment tool, grounded in linguistic theory and the Mixed Methods Appraisal Tool. A narrative synthesis guided by the linguistic concept of metafunction was performed to synthesise the findings. RESULTS Of the 2883 abstracts reviewed five formed the basis of the review. Interactions between IBD nurses and patients have been mostly characterised in terms of information provision regarding prescribed medications without consideration of the interpersonal aspect. Discussing online medical information with nurses has been shown to improve patient satisfaction. Analyses of gastroenterologist-patient interactions have concentrated on the clinical relationship which has been shown to be disease-centred. Shared decision making in ulcerative colitis has been shown to be compromised due to lack of transparency regarding treatment goals. LIMITATIONS This review did not include articles in languages other than English. Cumulative evidence could not be produced due to the small number of included studies and the diversity of contexts, theories and data types. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS There is a paucity of systematic research on naturally occurring clinical communication in IBD and its effect on outcomes. Further research needs to be done to address this knowledge gap. PROSPERO REGISTRATION NUMBER CRD42020169657.
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Affiliation(s)
- Neda Karimi
- Gastroenterology and Liver Research Group, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- South Western Sydney Clinical School, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Ria Kanazaki
- Gastroenterology and Liver Research Group, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- South Western Sydney Clinical School, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Gastroenterology Department, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Annabelle Lukin
- Department of Linguistics, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Alison Rotha Moore
- English Language & Linguistics, Faculty of Law Humanities and the Arts, University of Wollongong, Wollongong, New South Wales, Australia
| | - Astrid-Jane Williams
- Gastroenterology and Liver Research Group, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- South Western Sydney Clinical School, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Gastroenterology Department, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Susan Connor
- Gastroenterology and Liver Research Group, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- South Western Sydney Clinical School, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Gastroenterology Department, Liverpool Hospital, Liverpool, New South Wales, Australia
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Williams MS. Misdiagnosis: Burnout, moral injury, and implications for the electronic health record. J Am Med Inform Assoc 2021; 28:1047-1050. [PMID: 33164089 DOI: 10.1093/jamia/ocaa244] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/17/2020] [Indexed: 11/14/2022] Open
Abstract
Burnout is a long-term stress reaction marked by emotional exhaustion, depersonalization, and a lack of sense of personal accomplishment. Burnout in clinicians is receiving significant attention. Some have proposed that clinicians are experiencing symptoms of moral injury, defined as "perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations." Current efforts to improve the electronic health record (EHR) have focused on improving the user experience to reduce burden that has been identified as a contributing factor to provider burnout. However, if EHRs are contributing to moral injury, improvements to user experience will not eliminate the effects on providers. Current research has not evaluated the risk for moral injury resulting from the use of EHRs. This Perspective reviews the differences between burnout and moral injury, discusses the implications for clinicians using EHRs, and highlights the need for research to better define the problem.
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Affiliation(s)
- Marc S Williams
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania, USA
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Lanier C, Dominicé Dao M, Baer D, Haller DM, Sommer J, Junod Perron N. How Do Patients Want Us to Use the Computer During Medical Encounters?-A Discrete Choice Experiment Study. J Gen Intern Med 2021; 36:1875-1882. [PMID: 33904040 PMCID: PMC8298679 DOI: 10.1007/s11606-021-06753-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 03/22/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Primary care physicians (PCPs) now widely use electronic health records (EHRs) during medical encounters. Experts in clinical communication issued recommendations for a patient-centered use of EHRs. However, they have never been validated by patients themselves. OBJECTIVE To explore patients' preferences regarding physicians' EHR-related behaviors. DESIGN Discrete choice experiment study. PATIENTS French-speaking patients waiting for a medical consultation at two outpatient clinics in Geneva, Switzerland. MAIN MEASURES We invited patients to watch videos displaying 2 or 3 variations of four specific EHR-related behaviors and asked them to indicate which one they preferred. EHR-related behaviors were (1) typing: continuous/intermittent/handwriting in biomedical or psychosocial focused consultations; (2) maintaining contact while typing: visual/verbal/both; (3) signposting the use of EHR: with/without; (4) position of physicians' hands and bust: on the keyboard and towards the patient/away from the keyboard and towards the patient/on the keyboard and towards the screen. KEY RESULTS Three hundred thirty-six patients participated (response rate 61.4%). They preferred intermittent typing versus handwriting or continuous typing for biomedical issues (32.7%; 95% CI: 26.0-40.2% vs 31.6%; 95% CI: 24.9-39.0% or 14.9%; 95% CI: 10.2-21.1%) and psychosocial issues (38.7%; 95% CI: 31.6-46.3% vs 24.4% 95% CI: 18.4-31.5% or 17.9%; 95% CI; 12.7-24.4%). They favored visual and verbal contact (38.9%; 95% CI: 31.9-46.3%) over verbal (30.3%; 95% CI: 23.9-37.5%) or visual contact only (11.4%; 95% CI: 7.5-17.1%) while the doctor was typing. A majority preferred signposting the use of EHR versus no signposting (58.9%; 95% CI: 53.5-64.0% vs 34.8%; 95% CI: 29.9-40.1%). Finally, half of the patients (49.7%; 95% CI: 42.0-57.4%) favored the position with the physician's bust towards the patient and hands away from the keyboard. CONCLUSIONS Our study shows that patients' preferences regarding EHR-related behaviors are in line with most experts' recommendations. Such recommendations should be more consistently integrated into under- and postgraduate communication skills training.
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Affiliation(s)
- Cédric Lanier
- Primary Care unit (UIGP), BFM local 4091, Centre Médical Universitaire de Genève, University of Geneva, Geneva, Switzerland.
| | - Melissa Dominicé Dao
- Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | | | - Dagmar M Haller
- Primary Care unit (UIGP), BFM local 4091, Centre Médical Universitaire de Genève, University of Geneva, Geneva, Switzerland
| | - Johanna Sommer
- Primary Care unit (UIGP), BFM local 4091, Centre Médical Universitaire de Genève, University of Geneva, Geneva, Switzerland
| | - Noëlle Junod Perron
- Unit of Development and Research in Medical Education (UDREM), University of Geneva, Geneva, Switzerland
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Ouyang ZB, Hodgson JL, Robson E, Havas K, Stone E, Poljak Z, Bernardo TM. Day-1 Competencies for Veterinarians Specific to Health Informatics. Front Vet Sci 2021; 8:651238. [PMID: 34179157 PMCID: PMC8231916 DOI: 10.3389/fvets.2021.651238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 04/21/2021] [Indexed: 11/13/2022] Open
Abstract
In 2015, the American Association of Veterinary Medical Colleges (AAVMC) developed the Competency-Based Veterinary Education (CBVE) framework to prepare practice-ready veterinarians through competency-based education, which is an outcomes-based approach to equipping students with the skills, knowledge, attitudes, values, and abilities to do their jobs. With increasing use of health informatics (HI: the use of information technology to deliver healthcare) by veterinarians, competencies in HI need to be developed. To reach consensus on a HI competency framework in this study, the Competency Framework Development (CFD) process was conducted using an online adaptation of Developing-A-Curriculum, an established methodology in veterinary medicine for reaching consensus among experts. The objectives of this study were to (1) create an HI competency framework for new veterinarians; (2) group the competency statements into common themes; (3) map the HI competency statements to the AAVMC competencies as illustrative sub-competencies; (4) provide insight into specific technologies that are currently relevant to new veterinary graduates; and (5) measure panelist satisfaction with the CFD process. The primary emphasis of the final HI competency framework was that veterinarians must be able to assess, select, and implement technology to optimize the client-patient experience, delivery of healthcare, and work-life balance for the veterinary team. Veterinarians must also continue their own education regarding technology by engaging relevant experts and opinion leaders.
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Affiliation(s)
- Zenhwa Ben Ouyang
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Jennifer Louise Hodgson
- Department of Population Health Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, United States
| | | | | | - Elizabeth Stone
- Department of Clinical Studies, University of Guelph, Guelph, ON, Canada
| | - Zvonimir Poljak
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Theresa Marie Bernardo
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
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Jacobsen E, Drummond S, Biagioli FE, Cantone RE. Assessing Physician Assistant Student Electronic Health Record Competency Using an Objective Structured Clinical Examination. J Physician Assist Educ 2021; 32:93-96. [PMID: 34004647 DOI: 10.1097/jpa.0000000000000354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Evaluate didactic year physician assistant (PA) student competency in electronic health record (EHR) communication and data management. METHODS This study used an Objective Structured Clinical Examination (OSCE) to measure PA students' EHR patient communication and data skills. RESULTS Most students demonstrated good EHR communication skills overall, while few students moved the computer to better facilitate the visit or verified the patient's identity. Additionally, few students demonstrated EHR data skills by reviewing patient history and medications. CONCLUSIONS Utilizing an OSCE to assess EHR competence can highlight areas for curricular improvement in order to improve EHR skills.
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Affiliation(s)
- Emily Jacobsen
- Emily Jacobsen, PA-C, is an assistant professor in the Division of Physician Assistant Education at Oregon Health & Science University, School of Medicine, Portland, Oregon
- Sarah Drummond, EdD, is an assistant professor and the director of Research and Assessment in the Division of Physician Assistant Education at Oregon Health & Science University, School of Medicine, Portland, Oregon
- Frances Emily Biagioli, MD, is a professor and vice chair for Education in the Department of Family Medicine at Oregon Health & Science University, School of Medicine, Portland, Oregon
- Rebecca E. Cantone, MD, is an assistant professor of Department of Family Medicine and OHSU School of Medicine Assistant Dean of Undergraduate Medical Education Student Affairs, director of Family Medicine (FM) Student Education, and director of FM Core Clinical Experience at Oregon Health & Science University, School of Medicine, Portland, Oregon
| | - Sarah Drummond
- Emily Jacobsen, PA-C, is an assistant professor in the Division of Physician Assistant Education at Oregon Health & Science University, School of Medicine, Portland, Oregon
- Sarah Drummond, EdD, is an assistant professor and the director of Research and Assessment in the Division of Physician Assistant Education at Oregon Health & Science University, School of Medicine, Portland, Oregon
- Frances Emily Biagioli, MD, is a professor and vice chair for Education in the Department of Family Medicine at Oregon Health & Science University, School of Medicine, Portland, Oregon
- Rebecca E. Cantone, MD, is an assistant professor of Department of Family Medicine and OHSU School of Medicine Assistant Dean of Undergraduate Medical Education Student Affairs, director of Family Medicine (FM) Student Education, and director of FM Core Clinical Experience at Oregon Health & Science University, School of Medicine, Portland, Oregon
| | - Frances Emily Biagioli
- Emily Jacobsen, PA-C, is an assistant professor in the Division of Physician Assistant Education at Oregon Health & Science University, School of Medicine, Portland, Oregon
- Sarah Drummond, EdD, is an assistant professor and the director of Research and Assessment in the Division of Physician Assistant Education at Oregon Health & Science University, School of Medicine, Portland, Oregon
- Frances Emily Biagioli, MD, is a professor and vice chair for Education in the Department of Family Medicine at Oregon Health & Science University, School of Medicine, Portland, Oregon
- Rebecca E. Cantone, MD, is an assistant professor of Department of Family Medicine and OHSU School of Medicine Assistant Dean of Undergraduate Medical Education Student Affairs, director of Family Medicine (FM) Student Education, and director of FM Core Clinical Experience at Oregon Health & Science University, School of Medicine, Portland, Oregon
| | - Rebecca E Cantone
- Emily Jacobsen, PA-C, is an assistant professor in the Division of Physician Assistant Education at Oregon Health & Science University, School of Medicine, Portland, Oregon
- Sarah Drummond, EdD, is an assistant professor and the director of Research and Assessment in the Division of Physician Assistant Education at Oregon Health & Science University, School of Medicine, Portland, Oregon
- Frances Emily Biagioli, MD, is a professor and vice chair for Education in the Department of Family Medicine at Oregon Health & Science University, School of Medicine, Portland, Oregon
- Rebecca E. Cantone, MD, is an assistant professor of Department of Family Medicine and OHSU School of Medicine Assistant Dean of Undergraduate Medical Education Student Affairs, director of Family Medicine (FM) Student Education, and director of FM Core Clinical Experience at Oregon Health & Science University, School of Medicine, Portland, Oregon
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Kripalani S, Gaughan JP, Cerceo E. The Role of Religion in Physician Outlook on Death, Dying, and End of Life Care. JOURNAL OF RELIGION AND HEALTH 2021; 60:2109-2124. [PMID: 33386571 DOI: 10.1007/s10943-020-01126-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 06/12/2023]
Abstract
One of the many roles a physician provides to their patients is compassion and comfort, which includes tending to any psychological, spiritual, and religious needs the patient has. The goal of this pilot study was to explore whether religious or spiritual values of physicians at an urban academic hospital affect how physicians care for and communicate with their patients, especially when dealing with death, dying, and end-of-life matters. After surveying 111 inpatient physicians at an academic hospital, we found that 92% of physicians are extremely or somewhat comfortable having end-of-life discussions. We also found that physician religiosity and spirituality are not necessarily required for discussing death and dying and that the religious and spiritual values of the physician do not correlate with their ability to have end-of-life conversations with the patient. We found no difference between years in practice and comfort discussing religion and spirituality, though we did find that, of the physicians who believe they are comfortable talking to patients about religion or belief systems, most of them had more than five end-of-life patients in the past 12 months. Lastly, referrals to Palliative Care or pastoral services were not impacted by the physician's religious or spiritual beliefs. Future studies can explore how religious beliefs may more subtly influence physicians' interactions with patients, patient satisfaction, and physician well-being and resilience.
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Cross DA, Levin Z, Raj M. Patient Portal Use, Perceptions of Electronic Health Record Value, and Self-Rated Primary Care Quality Among Older Adults: Cross-sectional Survey. J Med Internet Res 2021; 23:e22549. [PMID: 33970111 PMCID: PMC8145092 DOI: 10.2196/22549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/09/2020] [Accepted: 03/24/2021] [Indexed: 01/29/2023] Open
Abstract
Background Older adults are increasingly accessing information and communicating using patient-facing portals available through their providers’ electronic health record (EHR). Most theories of technology acceptance and use suggest that patients’ overall satisfaction with care should be independent of their chosen level of portal engagement. However, achieving expected benefits of portal use depends on demonstrated support from providers to meet these expectations. This is especially true among older adults, who may require more guidance. However, little is known about whether misalignment of expectations around technology-facilitated care is associated with lower perceptions of care quality. Objective The aims of this study were to analyze whether older adults’ assessment of primary care quality differs across levels of patient portal engagement and whether perceptions of how well their provider uses the EHR to support care moderates this relationship. Methods We conducted a cross-sectional survey analysis of 158 older adults over the age of 65 (average age 71.4 years) across Michigan using a 13-measure composite of self-assessed health care quality. Portal use was categorized as none, moderate (use of 1-3 functionalities), or extensive (use of 4-7 functionalities). EHR value perception was measured by asking respondents how they felt their doctor’s EHR use improved the patient–provider relationship. Results Moderate portal users, compared to those who were extensive users, had lower estimated care quality (–0.214 on 4-point scale; P=.03). Differences between extensive portal users and nonportal users were not significant. Quality perception was only particularly low among moderate portal users with low EHR value perception; those with high EHR value perception rated quality similarly to other portal user groups. Conclusions Older adults who are moderate portal users are the least satisfied with their care, and the most sensitive to perceptions of how well their provider uses the EHR to support the relationship. Encouraging portal use without compromising perceptions of quality requires thinking beyond patient-focused education. Achieving value from use of patient-facing technologies with older adults is contingent upon matched organizational investments that support technology-enabled care delivery. Providers and staff need policies and practices that demonstrate technology adeptness. Older adults may need more tailored signaling and accommodation for technology to be maximally impactful.
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Affiliation(s)
- Dori A Cross
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, United States
| | - Zachary Levin
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, United States
| | - Minakshi Raj
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana-Champaign, IL, United States
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Helou S, Abou-Khalil V, Iacobucci R, El Helou E, Kiyono K. Automatic Classification of Screen Gaze and Dialogue in Doctor-Patient-Computer Interactions: Computational Ethnography Algorithm Development and Validation. J Med Internet Res 2021; 23:e25218. [PMID: 33970117 PMCID: PMC8145082 DOI: 10.2196/25218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/07/2021] [Accepted: 04/14/2021] [Indexed: 12/04/2022] Open
Abstract
Background The study of doctor-patient-computer interactions is a key research area for examining doctor-patient relationships; however, studying these interactions is costly and obtrusive as researchers usually set up complex mechanisms or intrude on consultations to collect, then manually analyze the data. Objective We aimed to facilitate human-computer and human-human interaction research in clinics by providing a computational ethnography tool: an unobtrusive automatic classifier of screen gaze and dialogue combinations in doctor-patient-computer interactions. Methods The classifier’s input is video taken by doctors using their computers' internal camera and microphone. By estimating the key points of the doctor's face and the presence of voice activity, we estimate the type of interaction that is taking place. The classification output of each video segment is 1 of 4 interaction classes: (1) screen gaze and dialogue, wherein the doctor is gazing at the computer screen while conversing with the patient; (2) dialogue, wherein the doctor is gazing away from the computer screen while conversing with the patient; (3) screen gaze, wherein the doctor is gazing at the computer screen without conversing with the patient; and (4) other, wherein no screen gaze or dialogue are detected. We evaluated the classifier using 30 minutes of video provided by 5 doctors simulating consultations in their clinics both in semi- and fully inclusive layouts. Results The classifier achieved an overall accuracy of 0.83, a performance similar to that of a human coder. Similar to the human coder, the classifier was more accurate in fully inclusive layouts than in semi-inclusive layouts. Conclusions The proposed classifier can be used by researchers, care providers, designers, medical educators, and others who are interested in exploring and answering questions related to screen gaze and dialogue in doctor-patient-computer interactions.
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Affiliation(s)
- Samar Helou
- Global Center for Medical Engineering and Informatics, Osaka University, Osaka, Japan
| | | | - Riccardo Iacobucci
- Department of Urban Management, Graduate School of Engineering, Kyoto University, Kyoto, Japan
| | - Elie El Helou
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Ken Kiyono
- Graduate School of Engineering Science, Osaka University, Osaka, Japan
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Alcocer Alkureishi M, Lenti G, Choo ZY, Castaneda J, Weyer G, Oyler J, Lee WW. Teaching Telemedicine: The Next Frontier for Medical Educators. JMIR MEDICAL EDUCATION 2021; 7:e29099. [PMID: 33878011 PMCID: PMC8086780 DOI: 10.2196/29099] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 05/04/2023]
Abstract
The COVID-19 pandemic has pushed telemedicine to the forefront of health care delivery, and for many clinicians, virtual visits are the new normal. Although telemedicine has allowed clinicians to safely care for patients from a distance during the current pandemic, its rapid adoption has outpaced clinician training and development of best practices. Additionally, telemedicine has pulled trainees into a new virtual education environment that finds them oftentimes physically separated from their preceptors. Medical educators are challenged with figuring out how to integrate learners into virtual workflows while teaching and providing patient-centered virtual care. In this viewpoint, we review principles of patient-centered care in the in-person setting, explore the concept of patient-centered virtual care, and advocate for the development and implementation of patient-centered telemedicine competencies. We also recommend strategies for teaching patient-centered virtual care, integrating trainees into virtual workflows, and developing telemedicine curricula for graduate medical education trainees by using our TELEMEDS framework as a model.
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Affiliation(s)
| | - Gena Lenti
- Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Zi-Yi Choo
- Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Jason Castaneda
- Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - George Weyer
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Julie Oyler
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Wei Wei Lee
- Department of Medicine, University of Chicago, Chicago, IL, United States
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Alkureishi MA, Johnson T, Nichols J, Dhodapkar M, Czerwiec MK, Wroblewski K, Arora VM, Lee WW. Impact of an Educational Comic to Enhance Patient-Physician-Electronic Health Record Engagement: Prospective Observational Study. JMIR Hum Factors 2021; 8:e25054. [PMID: 33908891 PMCID: PMC8116991 DOI: 10.2196/25054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/06/2021] [Accepted: 03/18/2021] [Indexed: 01/16/2023] Open
Abstract
Background Electronic health record (EHR) use can impede or augment patient-physician communication. However, little research explores the use of an educational comic to improve patient-physician-EHR interactions. Objective To evaluate the impact of an educational comic on patient EHR self-advocacy behaviors to promote patient engagement with the EHR during clinic visits. Methods We conducted a prospective observational study with adult patients and parents of pediatric patients at the University of Chicago General Internal Medicine (GIM) and Pediatric Primary Care (PPC) clinics. We developed an educational comic highlighting EHR self-advocacy behaviors and distributed it to study participants during check-in for their primary care visits between May 2017 and May 2018. Participants completed a survey immediately after their visit, which included a question on whether they would be interested in a follow-up telephone interview. Of those who expressed interest, 50 participants each from the adult and pediatric parent cohorts were selected at random for follow-up telephone interviews 8 months (range 3-12 months) post visit. Results Overall, 71.0% (115/162) of adult patients and 71.6% (224/313) of pediatric parents agreed the comic encouraged EHR involvement. African American and Hispanic participants were more likely to ask to see the screen and become involved in EHR use due to the comic (adult P=.01, P=.01; parent P=.02, P=.006, respectively). Lower educational attainment was associated with an increase in parents asking to see the screen and to be involved (ρ=−0.18, P=.003; ρ=−0.19, P<.001, respectively) and in adults calling for physician attention (ρ=−0.17, P=.04), which was confirmed in multivariate analyses. Female GIM patients were more likely than males to ask to be involved (median 4 vs 3, P=.003). During follow-up phone interviews, 90% (45/50) of adult patients and all pediatric parents (50/50) remembered the comic. Almost half of all participants (GIM 23/50, 46%; PPC 21/50, 42%) recalled at least one best-practice behavior. At subsequent visits, adult patients reported increases in asking to see the screen (median 3 vs 4, P=.006), and pediatric parents reported increases in asking to see the screen and calling for physician attention (median 3 vs 4, Ps<.001 for both). Pediatric parents also felt that the comic had encouraged them to speak up and get more involved with physician computer use since the index visit (median 4 vs 4, P=.02) and that it made them feel more empowered to get involved with computer use at future visits (median 3 vs 4, P<.001). Conclusions Our study found that an educational comic may improve patient advocacy for enhanced patient-physician-EHR engagement, with higher impacts on African American and Hispanic patients and patients with low educational attainment.
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Affiliation(s)
- Maria A Alkureishi
- Department of Academic Pediatrics, University of Chicago, Chicago, IL, United States
| | - Tyrone Johnson
- Department of Internal Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Jacqueline Nichols
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
| | - Meera Dhodapkar
- Yale University School of Medicine, New Haven, CT, United States
| | - M K Czerwiec
- Center for Medical Humanities & Bioethics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Kristen Wroblewski
- Department of Public Health Sciences, University of Chicago, Chicago, IL, United States
| | - Vineet M Arora
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Wei Wei Lee
- Department of Medicine, University of Chicago, Chicago, IL, United States
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Electronic health records and patient registries in medical oncology departments in Spain. Clin Transl Oncol 2021; 23:2099-2108. [PMID: 33864619 PMCID: PMC8390424 DOI: 10.1007/s12094-021-02614-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/30/2021] [Indexed: 11/23/2022]
Abstract
Purpose We aimed to evaluate the current situation of electronic health records (EHRs) and patient registries in the oncology departments of hospitals in Spain. Methods This was a cross-sectional study conducted from December 2018 to September 2019. The survey was designed ad hoc by the Outcomes Evaluation and Clinical Practice Section of the Spanish Society of Medical Oncology (SEOM) and was distributed to all head of medical oncology department members of SEOM. Results We invited 148 heads of oncology departments, and 81 (54.7%) questionnaires were completed, with representation from all 17 Spanish autonomous communities. Seventy-seven (95%) of the respondents had EHRs implemented at their hospitals; of them, over 80% considered EHRs to have a positive impact on work organization and clinical practice, and 73% considered that EHRs improve the quality of patient care. In contrast, 27 (35.1%) of these respondents felt that EHRs worsened the physician–patient relationship and conveyed an additional workload (n = 29; 37.6%). Several drawbacks in the implementation of EHRs were identified, including the limited inclusion of information on both outpatients and inpatients, information recorded in free text data fields, and the availability of specific informed consent. Forty-six (56.7%) respondents had patient registries where they recorded information from all patients seen in the department. Conclusion Our study indicates that EHRs are almost universally implemented in the hospitals surveyed and are considered to have a positive impact on work organization and clinical practice. However, EHRs currently have several drawbacks that limit their use for investigational purposes. Clinical trial registration Not applicable Supplementary Information The online version contains supplementary material available at 10.1007/s12094-021-02614-9.
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Chang HH, Wong KH, Hung CR. Health Beliefs and Social Support Related to Anxiety about Electronic Health Record Systems: A Patient Visit Survey (Preprint). JMIR Form Res 2021. [DOI: 10.2196/29075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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North F, Pecina JL, Tulledge-Scheitel SM, Chaudhry R, Matulis JC, Ebbert JO. Is a switch to a different electronic health record associated with a change in patient satisfaction? J Am Med Inform Assoc 2021; 27:867-876. [PMID: 32357370 PMCID: PMC7309264 DOI: 10.1093/jamia/ocaa026] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 02/09/2020] [Accepted: 02/28/2020] [Indexed: 11/14/2022] Open
Abstract
Objective Financial impacts associated with a switch to a different electronic health record (EHR) have been documented. Less attention has been focused on the patient response to an EHR switch. The Mayo Clinic was involved in an EHR switch that occurred at 6 different locations and with 4 different “go-live” dates. We sought to understand the relationship between patient satisfaction and the transition to a new EHR. Materials and Methods We used patient satisfaction data collected by Press Ganey from July 2016 through December 2019. Our patient satisfaction measure was the percent of patients responding “very good” (top box) to survey questions. Twenty-four survey questions were summarized by Press Ganey into 6 patient satisfaction domains. Piecewise linear regression was used to model patient satisfaction before and after the EHR switch dates. Results Significant drops in patient satisfaction were associated with the EHR switch. Patient satisfaction with access (ease of getting clinic on phone, ease of scheduling appointments, etc.) was most affected (range of 6 sites absolute decline: -3.4% to -8.8%; all significant at 99% confidence interval). Satisfaction with providers was least affected (range of 6 sites absolute decline: -0.5% to -2.8%; 4 of 6 sites significant at 99% confidence interval). After 9-15 months, patient satisfaction with access climbed back to pre-EHR switch levels. Conclusions Patient satisfaction in several patient experience domains dropped significantly and stayed lower than pre–“go-live” for several months after a switch in EHR. Satisfaction with providers declined less than satisfaction with access.
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Affiliation(s)
- Frederick North
- Division of Community Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jennifer L Pecina
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sidna M Tulledge-Scheitel
- Division of Community Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Rajeev Chaudhry
- Division of Community Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - John C Matulis
- Division of Community Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jon O Ebbert
- Division of Community Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Glancova A, Do QT, Sanghavi DK, Franco PM, Gopal N, Lehman LM, Dong Y, Pickering BW, Herasevich V. Are We Ready for Video Recognition and Computer Vision in the Intensive Care Unit? A Survey. Appl Clin Inform 2021; 12:120-132. [PMID: 33626583 DOI: 10.1055/s-0040-1722614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE Video recording and video recognition (VR) with computer vision have become widely used in many aspects of modern life. Hospitals have employed VR technology for security purposes, however, despite the growing number of studies showing the feasibility of VR software for physiologic monitoring or detection of patient movement, its use in the intensive care unit (ICU) in real-time is sparse and the perception of this novel technology is unknown. The objective of this study is to understand the attitudes of providers, patients, and patient's families toward using VR in the ICU. DESIGN A 10-question survey instrument was used and distributed into two groups of participants: clinicians (MDs, advance practice providers, registered nurses), patients and families (adult patients and patients' relatives). Questions were specifically worded and section for free text-comments created to elicit respondents' thoughts and attitudes on potential issues and barriers toward implementation of VR in the ICU. SETTING The survey was conducted at Mayo Clinic in Minnesota and Florida. RESULTS A total of 233 clinicians' and 50 patients' surveys were collected. Both cohorts favored VR under specific circumstances (e.g., invasive intervention and diagnostic manipulation). Acceptable reasons for VR usage according to clinicians were anticipated positive impact on patient safety (70%), and diagnostic suggestions and decision support (51%). A minority of providers was concerned that artificial intelligence (AI) would replace their job (14%) or erode professional skills (28%). The potential use of VR in lawsuits (81% clinicians) and privacy breaches (59% patients) were major areas of concern. Further identified barriers were lack of trust for AI, deterioration of the patient-clinician rapport. Patients agreed with VR unless it does not reduce nursing care or record sensitive scenarios. CONCLUSION The survey provides valuable information on the acceptance of VR cameras in the critical care setting including an overview of real concerns and attitudes toward the use of VR technology in the ICU.
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Affiliation(s)
- Alzbeta Glancova
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, United States
| | - Quan T Do
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, United States
| | - Devang K Sanghavi
- Department of Medicine, Mayo Clinic, Jacksonville, Florida, United States
| | - Pablo Moreno Franco
- Department of Medicine, Critical Care, Mayo Clinic, Jacksonville, Florida, United States
| | - Neethu Gopal
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, United States
| | - Lindsey M Lehman
- Mayo Clinic, Critical Care IMP, Rochester, Minnesota, United States
| | - Yue Dong
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Brian W Pickering
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, United States
| | - Vitaly Herasevich
- Department of Anesthesiology and Medicine, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, United States
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Soong TK, Ho CM. Artificial Intelligence in Medical OSCEs: Reflections and Future Developments. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2021; 12:167-173. [PMID: 33628074 PMCID: PMC7899303 DOI: 10.2147/amep.s287926] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/21/2021] [Indexed: 06/12/2023]
Abstract
With the advent of the age of Artificial Intelligence (AI), we seek to consider how AI could shape clinical examinations, specifically Objective Structured Clinical Examinations (OSCEs). OSCEs, whilst having its own limitations, could be further enhanced with new technologies like AI to help better assess and prepare our future clinicians. With the everchanging requirements on the modern clinician, we deliberate the strengths and weaknesses of AI, and the need for emphasis on different skills to complement rather than resist the tides of change. In conclusion, we feel that AI has the potential to be a strong driving force in remodelling OSCEs to support future doctors and could serve as a new frontier in medical education and beyond. That being said, we recognize the technology and its applications are still in its infancy, and further study will be needed to eluciate the role of AI in medical education and in the greater landscape of medical practice.
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Affiliation(s)
- Tse Kiat Soong
- Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Cheng-Maw Ho
- Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
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Medical Scribes: A First Step. J Pediatr Gastroenterol Nutr 2021; 72:181. [PMID: 33264181 DOI: 10.1097/mpg.0000000000002985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Patients' and physicians' perspectives and experiences on the quality of medical consultations: a qualitative study. INT J EVID-BASED HEA 2021; 18:247-255. [PMID: 31714340 DOI: 10.1097/xeb.0000000000000210] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM Medical consultation is not only one of the most important steps in disease diagnosis and patient treatment, but also every patient's right. The purpose of this review was to explore patients' and physicians' perspectives and experiences of the quality of medical consultations. METHODS A qualitative interview study was carried out in outpatient clinics. A combination of face-to-face and telephone interviews was used due to the geographical spread of the respondents. Interviews were recorded and transcribed verbatim. Thematic descriptive analysis was used to interpret the data. Eligible physicians (n = 21) and patients (n = 27) were invited to take part in a semistructured interview to explore the views, perceptions, and experiences of patients on various factors affecting the quality of medical consultations. RESULTS The consultation quality was categorized into three topics: structure quality, process quality, and outcome quality. Data synthesis identified the following major themes for structure quality of consultations: administrative-organizational quality (with eight subthemes), physical environment quality (with six subthemes), and educational quality (with three subthemes). In addition, process quality was categorized into two major themes: examination quality (with nine subthemes) and interpersonal quality (with 13 subthemes). Outcome quality consisted of three major themes: patient satisfaction (with four subthemes), clinical outcomes (with two subthemes), and organizational outcomes (with three subthemes). CONCLUSION Medical consultation plays a central role in the quality and effectiveness of the received health care. Using the indicators of consultation quality improvement can develop physicians' clinical competence and skills. Furthermore, decision-makers can use them to monitor and evaluate physicians' performance.
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Cole E, Valikodath NG, Maa A, Chan RVP, Chiang MF, Lee AY, Tu DC, Hwang TS. Bringing Ophthalmic Graduate Medical Education into the 2020s with Information Technology. Ophthalmology 2020; 128:349-353. [PMID: 33358411 DOI: 10.1016/j.ophtha.2020.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022] Open
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