Physician Characteristics - EHRs and Meaningful Use


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Research assessing the characteristics of physicians who use electronic health record systems and how these characteristics affect meaningful use of electronic systems.

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Physician Characteristics - EHRs and Meaningful Use

  1. 1. Relation of Physician, Patient, and EHR characteristics in Regards to Meaningful Use Sirisha Karri, Lindsey LaRue, Christopher Stearns
  2. 2. <ul><li>Key Issue </li></ul><ul><li>Address the effects of the electronic health record (EHR) on physician-patient encounters. </li></ul><ul><li>Meaningful use </li></ul><ul><li>Why? </li></ul><ul><li>To identify the factors that influence the manner by which physicians use the EHR with patients. </li></ul><ul><li>Barriers-EHR Implementation. </li></ul>
  3. 3. <ul><li>High lights </li></ul><ul><li>Spatial effects </li></ul><ul><li>Relational-perceptions </li></ul><ul><li>Educational issues </li></ul><ul><li>Structural-institutional and technological forces </li></ul><ul><li>Study was conducted on </li></ul><ul><li>Primary care offices, Interviews with patients ,office staff, physicians, Nurse-practitioner and computer advocates. </li></ul>
  4. 4. Key Findings: <ul><li>Key Findings: Study Identified 14 factors by with EHR influenced physician-patient interactions. </li></ul><ul><ul><li>Geographical, Relational, Educational, and Structural factors. </li></ul></ul><ul><ul><li>3 distinct physician practice styles: Informationally-focused, Interpersonal and Managerial. </li></ul></ul><ul><ul><li>Organizational culture that encourages and “institutionalizes” the EHR concept will maximize its potential. </li></ul></ul><ul><ul><li>Negative Aspects: </li></ul></ul><ul><ul><li>EHR becomes much like a third party to a conversation. </li></ul></ul><ul><ul><li>The same “flexibility” of EHR’s creates a “learning curve” </li></ul></ul><ul><ul><li>Lack of Education. (Patient and Physician). </li></ul></ul><ul><ul><li>Exposed the lack (in many cases) of a cohesive Patient Physician relationship. </li></ul></ul>
  5. 5. Shortcomings: <ul><li>Shortcomings: </li></ul><ul><ul><li>Non–English-speaking patients may have added new dimensions to the results. </li></ul></ul><ul><ul><li>Ethnographic study was conducted in only 4 Primary care offices. Leaves out a wide spectrum of data. </li></ul></ul><ul><ul><li>Study was qualitative. (Lack of data). </li></ul></ul><ul><ul><li>All the participants in the study used the same EHR software product. Characteristics of other EHR’s may have generate different responses. </li></ul></ul><ul><ul><li>Lack of audio-taping Patient Physician interviews. </li></ul></ul>
  6. 6. Tying it in with Meaningful Use: <ul><li>Before “Meaningful Use” can ever be realized, EHR’s must become a comfortable, well-understood (and supported) vital piece; in terms of the relationship between patients and physicians. </li></ul>
  7. 7. New Research Suggestions and Opportunities <ul><li>“ Cookbook” medicine </li></ul><ul><ul><li>As EHR use becomes more rampant, how will this affect the way medicine is practiced </li></ul></ul><ul><ul><li>Risk of relying to much clinical decision support </li></ul></ul><ul><ul><li>Continual monitoring and research to assure meaningful use </li></ul></ul><ul><li>Benefits of computer note pads </li></ul><ul><ul><li>Moving from desktop to mobile </li></ul></ul><ul><ul><li>How this may positively affect physician-patient-EHR interaction </li></ul></ul><ul><li>How is information reviewed? </li></ul><ul><ul><li>In room with patient during consult, or prior to the consult? </li></ul></ul><ul><ul><li>How do each affect speed and patient interaction? </li></ul></ul><ul><li>Non-English speaking patients </li></ul><ul><ul><li>How does this affect physician - patient - EHR system relationship? </li></ul></ul><ul><li>Is physician/patient interaction similar before and after EHR implementation? </li></ul><ul><li>Will patients be educated about the system features as EHRs become more common? </li></ul>
  8. 8. Benefits of Further Study <ul><li>Overall strategies for physicians to reach meaningful use </li></ul><ul><li>Help determine physician characteristics that bring about a cohesive relationship patient and EHR system </li></ul><ul><li>More understanding and belief in EHRs </li></ul><ul><ul><li>Both physician and patient perspective </li></ul></ul><ul><li>Find ways to avoid “cookbook” medicine </li></ul><ul><ul><li>Physicians first concern is the patient </li></ul></ul><ul><li>Collaborative charting between physician and patient </li></ul><ul><ul><li>Via mobile flat screen computers </li></ul></ul><ul><ul><li>More interacting of patient with EHR system </li></ul></ul>
  9. 9. Conclusions: <ul><li>The study brought into focus several previously undocumented factors that influence the role EHRs have on encounters between physicians and patients. It found that spatial, relational, educational, and structural factors play an important part in how this technology is used in medical encounters. Further attention to these factors and the questions raised by this investigation can facilitate integration of the EHR into medical practice and foster use of the EHR to enhance therapeutic relationships. </li></ul><ul><li>A Focus on ways to tailor EHR design to improve patient physician encounters could be a key factor in achieving Meaningful Use. </li></ul>
  10. 10. References: <ul><li>“ Physicians, Patients, and the Electronic Health Record: An Ethnographic Analysis”. William Ventres, MD, MA, Sarah Kooienga, FNP, Nancy Vuckovic, PhD, Ryan Marlin, MD, MPH, Peggy Nygren, MA , and Valerie Stewart, PhD . </li></ul><ul><li> </li></ul><ul><li> </li></ul>