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Patient EHR access leads to real engagement, improved care

Defining the patient experience remains a difficult conversation for leaders in clinics around the country. What this experience represents is obscurity in the context of what it means both in person and in the virtual setting of social media. While the discussion of electronic protected health information (ePHI) has already progressed to the level of how to facilitate sophisticated sharing, the nature of the interaction between people and these data remains a challenge.
The recent OpenNotes Oct. 11 public meeting reflected a need for a culture change with regard to physicians sharing a view of the electronic health record (EHR) notes screen during the patient visit. What’s new is the participatory environment wherein those physician notes in the medical record are visible to the patient while they are created during the encounter.
In part, the obscurity lies in the idea of how a patient might react to this information. Will she understand it? What kinds of questions might the patient have with this new insight? Is the patient ready for this abundance of information? These are just a few of the concerns that illustrate the need for the physician (and non-physician providers) and patient to find at a new common ground for their interactions.
Another aspect of this obscurity involves those other staff members who lack clinical training (e.g., administrative, clerical) but are going to be more engaged in communications with patients. Gone will be the days when a receptionist tells a patient, “I only care about what happens in front of me.” This phrase represents the old culture of care where this person sits in his chair with his most important objective being to stay out of the physician’s way and simply check patients in as they arrive.
With this new level of interaction between patient and clinic, there will also be a new level of participation involving these clinical employees. What this will look like has everything to do with the confidence and trust everyone has in the clinic to engage in this conversation about a new culture. The conversation will then continue with new job descriptions and performance measures for these non-medical staff members as they transition from just sitting in a chair to participating in care in the clinic. The patients have a new role in this as well as they must be willing to engage in this new level of care and interaction.
Among the obstacles facing this transformation is a shift from crisis management to health management — that is, the nature of care that this disclosure and participation mean in terms of patient interactions with the clinic. The nature of care has become a mutually understood culture wherein the patient and physician interact when a problem arises in the patient’s health. While there will continue to be emergency situations in the course of patient care, the obstacle of meeting the needs of a health management approach is one to be overcome by both clinic staff and patients.
Although EHR and other health information technology (HIT) tools can certainly impact gathering, organizing, reporting and sharing electronic information in exciting new ways, the emerging culture of interaction entails a conversation about being social in the clinic. What’s more, this is a conversation about engaging patients and being receptive to patients in ways that are much different than merely awaiting the next health crisis. The challenge of the physician trying to maintain eye contact while creating notes in the EHR will be extended to the implications of this information going forward with an ongoing dialogue. The willingness among physicians to engage and trust non-physician medical staff (e.g., nurses, physician’s assistants) in this communication process will be critical to both effective communication and workflow for the benefit of all those concerned in patient interaction.
Making good of the opportunity lies in leveraging the many the relationships that already exist between physicians and their patients. The personal trust that these people share is an incredible foundation for building stronger relationships through disclosure of patient notes during the encounter and welcoming the dialogue for improved health outcomes. This is about building both the physicians’ and clinic’s reputation of caring that is palpable within the community. It is a conversation about alignment among physicians in merged hospital systems and the independent physician networks in those communities as well.
Since the conversation of population health has already been well-established as a key outcome of EHR meaningful use, the foundation for a shared dialogue has already begun to supplant the threat of sharing and collaboration in a highly competitive marketplace. Better outcomes and alignment are driven by sharing best practices. With this new definition of patient experience as collaboration, there is a real opportunity to for any organization to differentiate itself from its competition based upon a commitment to move away from the commodity type of service where the patient waits for a health problem to arise to engage the clinic.
New conversations will emerge in the context of proactive sharing and education, perhaps even bringing patient communities into the clinic for support. The common patient comment in the past may have been, “I visited the clinic about a year ago and the physician was great, but I haven’t heard from them in about a year.” Many of these conversations between patients have been happening for a long time in communities and even in the world of social media. The opportunity to be receptive to engaging in these proactive and supportive conversations not only helps to improve outcomes of patients but also provides meaningful ways for a fully engaged clinic to keep in touch with all of those people amidst all of that ePHI. By shifting the patient interaction away from the crisis model to a socially interactive one, the reputation of the clinic and health outcomes for patients will be better than ever.
Robert Green is the author of Community Healthcare: Finding a Common Ground with New Expectations in Healthcare. Through his physician client relationships, Bob has gained substantial insight regarding the daily challenges that medical professionals and their staffs face, such as regulatory issues, financial management, and clinical collaboration through the use of health IT. His process of making both interpersonal and purposeful connections within the organization results in improved employee performance and confidence and enhanced client experience.
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