The Patient and the EHR

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The Patient and the EHR

• Tonya H. Howard, MSN, FNP-C
• Vermont Information Technology Leaders Summit
• September 2009

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Todays objectives

• Patient perceptions of the EHR
• Maintaining the human touch with the EHR
• Addressing privacy and security concerns with
  patients
• Enhancing patient interaction with an EHR

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What do people think?

• Almost half are unaware of EHR
• Those that are aware are generally positive
• 67 felt it would improve quality and safety
• 77 thought they would have more access and
  control over their records
• 72 thought EHR would enable providers to
  diagnose and treat in a more timely, informed
  manner

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The Positive Side

• Convenient, modern, analytical, speedy
• Safer Immediate results, legibility, organized
  information, information at hand
• Some felt it was mostly a convenience for the
  provider, relieving paper work, faster
• Many felt it will be helpful, but will not
  fundamentally change health care

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Fears and concerns Privacy and Security

• 76 felt the transition to EHR would increase the
  likelihood that unauthorized people will gain
  access
• The government
• Insurance companies
• Employers
• Healthcare marketing research (pharmaceutical
  companies, medical equipment companies, etc.)
• Fear of their information getting lost with
  system breakdowns
• Mixed opinion whether the risk is worth the
  benefits

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Fears and Concerns Interaction with the Provider

• Concerned about the loss of the human touch
• (Also a concern of healthcare providers)
• Feel it may alter the providers behavior toward
  themthey may become impersonal and detached
  (though they did not feel the same way about
  paper and pencil)

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Other Fears and Concerns

• The costs will be shifted to the patient
• More errors
• Loss of control of their records
• (Information summarized from a report from AHRQ
  that gathered information from literature review
  and 20 consumer focus groups conducted across the
  nation Consumer Engagement in Developing
  Electronic Health Information Systems, published
  July 2009)

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EHR Guest or Intruder?

• Becomes much like a third party in the exam room
  conversation
• The EHR has its own separate identity in the
  encounter which is different than the paper
  chart
• Both patients and providers project their
  perceptions onto this identity

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Research
Annals of Family Medicine, Physicians, Patients,
and the EHR An Ethnographic Analysis,
March/April 2006
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Research
Annals of Family Medicine, Physicians, Patients,
and the EHR An Ethnographic Analysis,
March/April 2006
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Addressing ConcernsPatient Relationship

• Set the stage for the transition
• When you are thinking about an EHR, consider what
  is in it for your patients make your project
  patient-centered
• Commit to maintaining the human touch
• Consider involving your patients in the process
• Make the physical integration of the EHR and
  related hardware help you toward your goal

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Physical Integration of the EHR

• Consider the following
• Eye contact
• Non-verbal message
• Privacy
• Using the EHR in your patient interaction during
  the visit

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Physical Integration Options Optimize
Communication With the Patient and Still Be
Efficient
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Additional Considerations

• Get enough training to be comfortable with the
  use of the EHR make ongoing small steps to be
  both more comfortable and more efficient while
  maintaining patient focus
• Acknowledge the EHR in the room
• Ask permission to begin entering information into
  the computer
• Enter/share information with the patient

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Privacy and Security

• Patient and publics primary concern with EHR
• Consider educating patients
• Informational brochure
• During intake and signing of consent for
  treatment and HIPAA forms
• Brief informational meeting with Q A
• Feel comfortable with your privacy and security
  procedures and protocolsit will assure patients
  if you are able to answer their questions with
  confidence
• Use privacy features for computers in areas
  accessible to patients

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Whats in it for me?

• PHR (Personal Health Record)
• Patient Portal
• Continuity of Care Document or Record (CCR or
  CCD)

• Some Patient Focused Benefits of an Electronic
  Health Record

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Personal health record (PHR)

• PHR may contain

• Possible PHR Platforms for Storage

• Allergies
• Medications
• PMH, FMH
• Surgical Hx
• Immunizations
• Lab Results

• Internet
• Smart Card
• USB Flash Drive
• CD-ROM
• DVD
• iPhone or other SmartPhone

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Patient Portal

• Healthcare related online applications that
  enable communication between patient and
  providers
• Can be hosted through an independent application,
  e.g.,
• MEDSEEK
• MedFusion
• Google Health
• Can be part of the practices website (may be
  provided by the EHR vendor for a price)

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Patient Portal Features

• Secure password protected
• Available 24 hours/day
• Scheduling, registration
• Pay bills
• Prescription Refills

• Communicate with provider or support staff
  (email)
• PHR
• Enter medical information HPI, PMH, FMH
• Check records for errors

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CCD Continuity of Care Document

• Electronic document containing specific
  information (similar to the PHR) that is
  digitally coded to facilitate transfer quickly to
  other electronic systems
• Contains U. S. specific requirements selected by
  the U.S. Healthcare Information Technology
  Standards Panel
• Makes is easier for patient medication
  information to pass between entities such as
  primary care providers, hospitals, emergency
  rooms, specialists, for storage as a PHR