Electronic Health Records


Relationship between EHR and patient engagement

By bob@xtelligentmedia.com

- Everyone is familiar with the typical visit to the medical clinic. It’s what we’ve come to know as the transactional experience in healthcare. It begins with the check-in between patient and clerical staff, followed by the face time for the patient with the clinical staff, and ends with the check-out for the patient back where she started in the reception area.

The understanding that patients have learned about this experience is that you make an appointment at the clinic when you think there might be some type of problem with your health. When you arrive at the clinic, the clinical staff will use their insight to determine cause(s) and make appropriate treatment options. It is also fair to include the maintenance visits like immunizations that are helpful in preventing some of those problem visits in the future.

But what about the rest of the times in the patient’s experiences?

The healthcare community at large continues to evolve in the use of electronic health records (EHR) and other health information technology (HIT) by facilitating accessibility and sharing of electronic information between clinic employees in the same organization, the clinic and patients, and between disparate healthcare organizations. A challenge with this shift is that the purposes of EHR and HIT have little to do with the conventional transactional experience in healthcare. In fact, this is such a relational dialogue that even the carrot and stick of the financial incentive associated with demonstrating meaningful use of EHR software has shown mixed results in encouraging adoption for those clinics who would qualify for this reward.

There is a larger dialogue here that has to do with that tradition of the transactional experience in the clinic setting between patients and physicians. Now that the dialogue of the use of electronic health information has been raised to collaboration both by those meaningful use guidelines for EHR and the individual expectations of patients who have chosen to be advocates for their health, the evolution of healthcare into the relational experience is underway. There are so many starting points for this new dialogue regarding workflow concerns within the clinic of ensuring that each staff member has access to the right information at the right time with the EHR software throughout the day. What’s more, there are the external concerns of how to redefine the patient experience without becoming completely overwhelmed in the fulfillment of care.

READ MORE: AMIA Calls For Patient Access to Complete Health Information

As this patient experience definition moves into a relational one, from the coordination of care to the online accessibility of the clinic through social media, it’s no longer just a matter of the patient checking-in and checking-out for care. It is precisely why this transition for so many people in clinics is such a difficult one in the course of decision-making with the selection and use of EHR and other HIT tools.

What this technology does is shift the outcomes of the patient experience in two important ways:

1. from an essentially one-way communication from physician to patient in the clinic to an ongoing two-way dialogue that is not bounded by the clinic walls, and
2. from the physician being the sole resource for the patient and the other staff just staying out of the way as much as possible.

The commitment of this expanded two-way dialogue between patient and the clinic represents a combination of willingness, ability, and sustainability among the entire clinic staff. The discussion of EHR and other HIT tools will inevitably include the words connectivity and collaboration in the context of their features and benefits. These two words represent the HIT environment for the clinic that will facilitate accessibility and sharing of information for the right people at the right time.

Similarly, connectivity and collaboration are also critical terms for the clinic environment in the culture of care, staff development, and the recognition of the patient experience within and beyond the clinic. Many of the examples that we’ve seen so far from patient portals to online educational materials are only starting points for the new expectations for expanded two-way dialogue between the clinic staff and patients. Keys to this conversation include:

READ MORE: EHR Clinical Decision Support Alerts Increase HPV Vaccination

• the patient experience as one not always defined by a crisis and support that may not always involve a visit to the clinic,
• social media is for sharing and listening (two-way) versus broadcasting (one-way).

The caveat for this discussion among leadership within the clinic is, “be careful what you wish for, you just might get it.”

The physician as the sole resource for the patient is unsustainable. Building on the idea of connectivity and collaboration means that if the clinic’s purpose is to attract and retain engaged patients, then the clinic must have a fully engaged staff. In addition to the physicians, people who serve in supporting roles in the clinic, whether it be clerical or clinical, must also understand how they contribute to the coordination of care and act as advocates for patients. This role of advocacy directly relates to that idea of two-way communication (i.e., listening and sharing) in the engaged clinic staff helping the patient and supporting colleagues within the clinic and beyond into their online community.

The expanded online presence will bring more opportunities to interact with patients in a meaningful way, but with some different expectations from those transactional clinic visits as well. One of these opportunities may be collaborating with other online communities of support for patients who share a common condition or experience. What this can represent for the clinic is one more way to sustain the attention of patients for continuing care and for new referrals as well.

The fully engaged staff who understands the connections between the physical world of the clinic and the virtual world of their online community will be invaluable in sustaining this new patient experience and the reputation of the clinic. The challenges of sustaining this combined clinic community of healthcare will require a fully engaged staff to be receptive to the patient across these multiple entry points into the clinic. HIT will always require structure and clarity in processes to be effective. A person on staff who acts with uncertainty in his role as an advocate for care or has a perceived reason to sustain a workaround to the structure presented by EHR and other HIT tools will not only diminish the value of these tools but the accountability of care as well.

READ MORE: Ensuring Patient Concerns Don’t Limit Health Data Exchange

Whatever the mix of tools within the clinic’s entire HIT environment one alternative definition of this acronym will also hold true — Human Interaction Throughout.

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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