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Patient, Provider Disagreement Re-emerges in Health Reporting

New research shows a gap between patient- and provider-reported health information, suggesting a need for providers to better engage with patients to maintain an accurate electronic record.


Source: Thinkstock

By Kate Monica

- A new study published in the Journal of the American Board of Family Medicine found patient-reported self-assessments and provider-reported assessments of patient health rarely align.

The study by Elder et al. aimed to gain insight into how often patient-reported information and provider-reported information were in exact agreement when rating patient health. Using a five-point scale to compare similarities between assessments of 506 patients and 33 physicians, researchers found assessments matched only 38 percent of the time.

“A closer look at the reasons given by patients and physicians helps explain that discordance,” the researchers wrote. “We found that physicians tended to focus on disease in their reasoning for all patients, whereas those patients with excellent and very good self-reported assessments focused on feeling well. In medicine, wellness is often considered the absence or prevention of disease, but other concepts within wellness, such as happiness and contentment, may be equally or more important to patients.”

While self-reported assessments are considered an important complement to provider-reported information in EHRs, small biases like emotional wellbeing potentially impacts patient opinion of personal physical health.

Because providers and patients appear to occasionally consider different factors when assessing a patient’s health, researchers believe more face-to-face discussion is imperative to closing gaps in knowledge of patient information and forming a more accurate overall assessment of health.

“Patients and physicians’ beliefs about patient health frequently lack agreement, confirming the need for shared decision making with patients,” claimed Elder et al.

Considering discussions regarding the lack of face-to-face interaction during visits have continued to crop up as a result of strict EHR reporting, this insight could motivate providers to continue to push for less stringent EHR reporting policies and shift the focus to forming open and honest patient-provider relationships.

 “Open and ongoing communication between physicians and patients, as recommended in motivational interviewing, remains key to patient-centered primary care,” the researchers concluded.

This finding echoes discrepancies between patient-reported information and provider-reported information in EHRs explored in another recent study by Valikodath et al. in which researchers compared patient-reported eye symptoms against clinical documentation in EHR systems.

“Discordance in symptom reporting could be because of differences in terminology of symptoms between the patient and clinician or errors of omission, such as forgetting or choosing not to report or record a symptom,” they wrote. “Perhaps a more bothersome symptom is the focus of the clinical encounter, and other less onerous symptoms (e.g., glare) are not discussed (or documented). However, even for the exclusive sensitivity analysis, we show that the ESQ and the EMR are inconsistently documented.”

Patients omitting symptoms when discussing their health issues with providers support the need for self-reported assessments. However, integrating this information into a patient’s EHR depends on providers prioritizing face-to-face interactions normally responsible for gathering most patient-reported information during visits.

“The original intent of the EMR was not for complete documentation of the clinical encounter but for physicians note taking of their patient interactions,” said Valikodath et al. “The EMR was implemented to integrate many sources of medical information.”

Studies such as these suggest the EHR technology has strayed slightly from its intended purpose.

While maintaining accurate EHR documentation provides for comprehensive view of a patient’s medical history is beneficial, these studies suggest the focus should be on gleaning new information from patients during visits and making joint provider-patient decisions on how best to determine a patient’s health and potential treatment options.

Empowering patients to feel comfortable disclosing symptoms to providers during visits could close gaps in knowledge ultimately leading to more accurate and efficient patient care. 



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