Impact of a brief faculty training to improve patient-centered communication while using electronic health records

How do opt-in versus opt-out settings nudge patients toward electronic health record adoption? An exploratory study of facilitators and barriers in Austria and France

BACKGROUND

Electronic health records (EHR) are becoming an integral part of the health system in many developed countries, though implementations and settings vary across countries. Some countries have adopted an opt-out policy, in which patients are enrolled in the EHR system following a default nudge, while others have applied an opt-in policy, where patients have to take action to opt into the system. While opt-in systems may exhibit lower levels of active user requests for access, this contrasts with opt-out systems where a notable percentage of users may passively retain access. Thus, our research endeavor aims to explore facilitators and barriers that contribute to explaining EHR usage (i.e., actively accessing the EHR system) in two countries with either an opt-in or opt-out setting, exemplified by France and Austria.

METHODS

A qualitative exploratory approach using a semi-structured interview guideline was undertaken in both countries: 1) In Austria, with four homogenously composed group discussions, and 2) in France, with 19 single patient interviews. The data were collected from October 2020 to January 2021.

RESULTS

Influencing factors were categorized into twelve subcategories. Patients have similar experiences in both countries with regard to all facilitating categories, for instance, the role of health providers, awareness of EHR and social norms. However, we highlighted important differences between the two systems regarding hurdles impeding EHR usage, namely, a lack of communication as well as transparency or information security about EHR.

CONCLUSION

Implementing additional safeguards to enhance privacy protection and supporting patients to improve their digital ability may help to diminish the perception of EHR-induced barriers and improve patients' health and commitment in the long term.

PRACTICAL IMPLICATIONS

Understanding the differences and similarities will help to develop practical implications to tackle the problem of low EHR usage rates in the long run. This problem is prevalent in countries with both types of EHR default settings.

The Effect of Characteristics of Patient Communication on Physician Feedback in Online Health Communities: An Observational Cross-Sectional Study

With the rapid development of e-health and telemedicine, previous studies have explored the relationship between physician-patient communication and patient satisfaction; however, there is a paucity of research on the influence of the characteristics of patient communication on the characteristics of physician feedback. Based on the communication accommodation theory, as well as the computer-mediated communication theory and media richness theory, this study aimed to explore how characteristics of patient communication influence characteristics of physician feedback in online health communities. We employed a crawler software to download the communication data between 1652 physicians and 105,325 patients from the Good Doctor platform, the biggest online health community in China. We built an empirical model using this data and employed a multilevel model to test our hypotheses using Stata and Python software. The results indicate that the amount of patients' rendered information positively influences the physicians' text (α = 0.123, t = 33.147, P < .001) and voice feedback (β = 0.201, t = 40.011, P < .001). Patients' hope for help signals and the provision of their electronic health records weaken the effect of the amount of patients' rendered information on physicians' text feedback (α = -0.040, t = -24.857, P < .001; α = -0.048, t = -15.784, P < .001), whereas, it strengthened the effect of the amount of patients' rendered information on physicians' voice feedback (β = 0.033, t = 14.789, P < .001; β = 0.017, t = 4.208, P < .001). Moreover, the occurrence of high-privacy diseases strengthened the effect of the amount of patients' presented information on physicians' text and voice feedback (α = 0.023, t = 4.870, P < .001; β = 0.028, t = 4.282, P < .001). This research contributes to the development of computer-mediated communication theories and sheds light on service delivery in the online health community.

A systematic review of faculty development programs based on the Harden teacher's role framework model

BACKGROUND

Despite the changing roles of faculty in the health professions over the past two decades, none of the reviews has been paid enough attention to the impact of the faculty development programs on these roles. The objective of this review is to synthesize the existing evidence that addresses the questions: "What are the types and outcomes of faculty development programs based on the Harden teachers' role framework and which of the areas described by Harden and Crosby are the authors referring to?"

METHODS

This review was conducted according to the guidance for Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. In 2020, a literature search was conducted in MEDLINE/PubMed, Scopus, ERIC, ScienceDirect, Google Scholar, Magiran and SID databases. The review included 119 studies (between 1990 and 2020) that met the review criteria. Data were extracted using a modified coding sheet. We used the modified Kirkpatrick model to assess the educational outcomes of faculty development programs.

RESULTS

The majority of faculty development programs were workshops (33.61%) with various durations. Most programs focused on the domain of information provider and coach (76.47%), followed by the facilitator of learning and mentor (53.78%) and assessor and diagnostician (37.81%). Only five faculty development programs focused on the domain of role model. The majority (83.19%) of outcomes reported were at level 2B, level 1 (73.95%) and level 2A (71.42%). Gains in knowledge and skills related to teaching methods and student assessment were frequently noted. Behavior changes included enhanced teaching performance, development of new educational curricula and programs, improved feedback and evaluation processes, new leadership positions, increased academic output and career development. The impact on the organizational practice continued to be underexplored.

CONCLUSION

Based on the review findings, broadening the scope of faculty development programs beyond the traditional roles of the faculty members by utilizing a competency-based framework for developing a comprehensive faculty development program is recommended. Attention to individualized form of faculty development programs and incorporating more informal approaches into the design and delivery of faculty development programs is also needed.

Use of the Electronic Health Record During Clinical Encounters: An Experience Survey

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.

Impact of an Educational Comic to Enhance Patient-Physician-Electronic Health Record Engagement: Prospective Observational Study

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.

Behavior change techniques to promote healthcare professionals' eHealth competency: A systematic review of interventions

INTRODUCTION

The use of eHealth is rapidly -->increasing; however, many healthcare professionals have insufficient eHealth competency. Consequently, interventions addressing eHealth competency might be useful in fostering the effective use of eHealth.

OBJECTIVE

Our systematic review aimed to identify and evaluate the behavior change techniques applied in interventions to promote healthcare professionals' eHealth competency.

METHODS

We conducted a systematic literature review following the Joanna Briggs Institute's Manual for Evidence Synthesis. Published quantitative studies were identified through screening PubMed, Embase, and CINAHL. Two reviewers independently performed full-text and quality assessment. Eligible interventions were targeted to any healthcare professional and aimed at promoting eHealth capability or motivation. We synthesized the interventions narratively using the Behavior Change Technique Taxonomy v1 and the COM-B model.

RESULTS

This review included 32 studies reporting 34 heterogeneous interventions that incorporated 29 different behavior change techniques. The interventions were most likely to improve the capability to use eHealth and less likely to enhance motivation toward using eHealth. The promising techniques to promote both capability and motivation were action planning and participatory approach. Information about colleagues' approval, emotional social support, monitoring emotions, restructuring or adding objects to the environment, and credible source are techniques worth further investigation.

CONCLUSIONS

We found that interventions tended to focus on promoting capability, although motivation would be as crucial for competent eHealth performance. Our findings indicated that empathy, encouragement, and user-centered changes in the work environment could improve eHealth competency as a whole. Evidence-based techniques should be favored in the development of interventions, and further intervention research should focus on nurses and multifaceted competency required for using different eHealth systems and devices.

Perspectives of English, Chinese, and Spanish-Speaking Safety-Net Patients on Clinician Computer Use: Qualitative Analysis

BACKGROUND

Safety-net systems serve patients with limited health literacy and limited English proficiency (LEP) who face communication barriers. However, little is known about how diverse safety-net patients feel about increasing clinician electronic health record (EHR) use.

OBJECTIVE

The aim of this study was to better understand how safety-net patients, including those with LEP, view clinician EHR use.

METHODS

We conducted focus groups in English, Spanish, and Cantonese (N=37) to elicit patient perspectives on how clinicians use EHRs during clinic visits. Using a grounded theory approach, we coded transcripts to identify key themes.

RESULTS

Across multiple language groups, participants accepted multitasking and silent clinician EHR use if focused on their care. However, participants desired more screen share and eye contact, especially when demonstrating physical concerns. All participants, including LEP participants, wanted clinicians to include them in EHR use.

CONCLUSIONS

Linguistically diverse patients accept the value of EHR use during outpatient visits but desire more eye contact, verbal warnings before EHR use, and screen-sharing. Safety-net health systems should support clinicians in completing EHR-related tasks during the visit using patient-centered strategies for all patients.