Communicating with Patients in an EHR Environment

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EHR RoadmapWebEx

• Communicating with Patients in an EHR Environment

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Presenter

• Margret Amatayakul
• RHIA, CHPS, CPHIT, CPEHR, FHIMSS
• President, Margret\A Consulting, LLC,
  Schaumburg, IL
• Consultant on the DOQ-IT Project for several
  QIOs
• Independent information management and
  systems consultant,
  focusing on EHRs and
  their value proposition
• Adjunct faculty College of St. Scholastica,
  Duluth, MN, masters program in health informatics
• Founder and former executive director of
  Computer-based Patient Record Institute,
  associate executive director AHIMA, associate
  professor Univ. of Ill., information services
  IEEI
• Active participant in standards development,
  HIMSS BOD, and co-founder of and faculty for
  Health IT Certification

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Objectives

• Recognize that the EHR has both similarities and
  differences from paper-based medical records when
  using them at the point of care
• Adopt applicable strategies in introducing the
  EHR to patients and others to optimize their use
• Adopt applicable strategies to achieve a comfort
  level with using the EHR at the point of care

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Communicating with Patients in an EHR Environment

• EHR vs. Paper
• at the Point of Care

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Purposes of Health Information

• Communication
• Among healthcare professionals
• Between providers
• To payers for reimbursement
• With many others
• More recently, with patients
• Documentation
• Evidence of care provided
• Education and research
• Knowledge Source and Support
• Access to knowledge bases
• Clinical guideline/protocol support for best
  practices
• Clinical decision support

Medical Record
vs.
EHR
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Goal for EHR

• Encompasses a broader view of the record than
  today,
• to move from the notion of location for keeping
  track of patient care events
• to a resource with much enhanced utility
• Institute of Medicine,
• Patient Record Study, 1991

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At Issue

• How do we overcome the issue of learning to use a
  very new, high-tech, complex process
• For something we learned how to do when we were
  children?
• How do we overcome the issue of displaying
  uncertainty in front of patients
• When we are highly educated, supposedly having
  the answers to their concerns?

From crayons to keystrokes
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Key Communication Points

• During EHR implementation
• At EHR go live
• During the EHR learning curve
• New patients in a mature EHR environment

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Communicating with Patients in an EHR Environment

• Strategies for Introducing EHR to Patients

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Support for EHR by Consumers
Oct. 14, 2005
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Oct. 14, 2005
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But Also Concerns About Security
July/August 2005
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During Implementation

• Patients may become aware of something going on
  during implementation
• First, be positive. An EHR will impact the
  patient in some way and everyone needs to be
  supportive
• Second, provide sufficient information to
  acknowledge your EHR project and allay potential
  fears, but it is not necessary to belabor the
  point
• Remember, some of your patients have been in an
  I.S. implementation themselves!
• Others may not understand the issues of an I.S.
  implementation at all and could become concerned
• Anticipate potential questions based on patient
  population
• Design a brochure to inform patients
• Develop a script to respond to questions
• Use a web site to introduce patients to both EHR
  and also encourage their use of computers

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Brochure(ware)

• We have a new computer system to help us keep
  track of our patients health information
• It helps us track medications youre taking so
• It helps us assure we have your lab results and
  other information we need to treat you
• It helps remind us about ways we can help keep
  you healthy, such as when you are due for a check
  up, or child needs his or her shots
• It protects your medical records in the event of
  a natural disaster so that your information will
  be available to your physician

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Also from AHIP Survey,

• Since most adults now use computers, the new
  patient Electronic Health Record system could
  arrange ways for consumers to track their own
  personal information in the new system and
  exercise the privacy rights they were promised.
• How important do you think it is that such
  individual consumer tools be incorporated in the
  new patient Electronic Health Record system from
  the start?

July/August 2005
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Patient Portal

• If you have or are planning a patient portal,
• A special part of our web site is available for
  you to
• Request (or make) appointments
• Exchange email securely with your provider for
  non-emergency questions
• Get your test results
• Get more information about your illness or injury
• Enter your personal medical history
• To use this site, please ask about getting your
  own user ID and password
• Remember, for life threatening emergencies,
  always call 911 first
• If you dont have a computer at home, you may use
  a computer at a kiosk in our waiting room. Dont
  hesitate to ask for assistance

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Plan for New Communication Devices

• What computer-human interface will you use?
• Is it friendly for sharing information with
  patient? (Example, does the screen swivel, can
  you share tablet with the patient)
• Speech dictation is not necessarily the panacea
  once thought there are
• Accuracy issues
• Speaking in front of patient
  issues

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Plan Physical Infrastructure

• Do you have the physical infrastructure to
  support use?
• Where will you put the computer-human interface
• During use?
• During non-use
  (examining patient)?
• How will you share data
  with the patient?
• How will you demonstrate
• Value?
• Security?

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At EHR Go Live

• Some EHR vendors actually supply under
  construction signs to advise patients they need
  to be understanding of your new EHR
• Remind staff to be
• Positive
• I hate this new system could
  make your patients
  hate it also
• Honest
• Were just learning how to use
  our new EHR
  system, so please
  bear with us
• Were new at this, I need to get
  some help so I do
  the right thing

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During the Learning Curve

• After greeting your patient,
• Introduce any assistant who may be present to
  help you use the EHR
• Explain to your patient that you are just
  implementing a new computer system
• Use the same script as on your brochure(ware)
• Offer that you may be a bit slow at first or may
  need to get help (if the assistant is not
  present)
• Although joking about new fangled systems can
  break the ice for you and your patient, remain
  positive and answer any questions, positively and
  honestly
• Before conducting an exam, ask the assistant to
  step out
• If you intend to use the EHR during the exam to
  record notes, be prepared to have some paper
  forms to use in documenting if you find you cant
  navigate the system during any point in the exam

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New Patients with Mature EHR

• Dont assume that a new patient will take to your
  EHR as well as you have!
• After greeting your patient for the first time,
  introduce the fact that your office uses an EHR
  follow your brochure(ware) script
• If patients do not seem at ease about this,
• Ask them if they have any questions
• Explain how helpful this has been for the
  practice
• Offer that you were skeptical initially as well,
  but have come to believe it makes difference in
  your ability to care for your patients
• Follow the script you used when the system was
  new to you

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Communicating with Patients in an EHR Environment

• Strategies for Using
• EHR at the Point of Care

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Overcoming the Barrier Myth

• You may feel like the computer is coming between
  you and your patient,
• But consider your position when you are writing
  notes in a paper chart
• Often the computer allows you to
  have better eye
  contact with patients
  than you do now!

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Using the EHR to Advantage

• In the past, youve shared some information with
  your patient, at least verbally
• Often youve shown them an x-ray, ECG strip, or
  other diagnostic study result so they could see
  the fracture, or tumor, or blockage of artery
• Now you have the capability to do that and more
• Provide tailored instructions
• Provide a summary of the visit

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Explaining Value to the Patient

• Tell the patient what the EHR is telling you
• Wow, it looks like youre due for your annual
  physical next month lets make sure you get that
  scheduled
• The system is telling me that your latest lab
  results indicate that the drug weve had you on
  for a while may too strong for you. There are
  some options that your insurer will pay for.
  Lets take a look at some of these (calling up a
  clinical comparison and/or price comparison)
• Use the computer to
• Show your patients a graph of their
  
  results over time
• To praise them for complying with
  their
  treatment regimen and
  improving their health
• To prod them into doing better
• Ask your patients to look at their
  medication list
  to see if it is current

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Assuring Patients of Security

• After you greet your patient and get ready to use
  the EHR
• Say you are logging on now to access their record
• If your system has a picture of them, address
  their appearance in an applicable manner to
  verify for them that you have accessed their
  record (e.g.,
• You look just the same as this
  picture we
  took of you last time
• You are looking a bit pale today
  
  lets see if we cant get you back to
  looking as
  chipper as you did in
  this picture
• When you conclude your session
  with the patient, say you
  are
  logging off so that their record
  will be filed
  securely

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Engaging the Patient

• Many patients have been curious about what you
  are writing in their record and have been too
  afraid to ask
• HIPAA provides patients the right to access their
  records, but this can feel like an adversarial
  act to the patient, even when that is not the
  intention
• There is a growing body of evidence
  that suggests
  engaging the patient
  aids in compliance
• Having the patient enter their own
  medical
  history aids you in getting
  this information documented
  for you to validate

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Take Your Communications Seriously

• The art of communicating with your patients is as
  valuable as the science your knowledge provides
• Use the computer as a resource with much
  enhanced utility
• You may soon find your patients expecting you to
  do so!

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This presentation was created by MetaStar under a
contract with the Centers for Medicare Medicaid
Services (CMS). The contents do not necessarily
reflect CMS policy.