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EMRs and Patient Engagement

The patient perspective on EMRsLaurie Edwards

About

Laurie Edwards has a BA from Georgetown University, an MFA in Nonfiction from Emerson College, and is incoming Director of Advanced Writing in the Disciplines at Northeastern University. Her work has appeared in the New York Times, the Boston Globe, Psychology Today, and many other outlets.

An award-winning patient advocate, she is the author of two books on chronic illness: Life Disrupted, a named a 2008 Best Consumer Health Book by Library Journal, and In the Kingdom of the Sick: A Social History of Chronic Illness in America, a 2013 Booklist Editor’s Choice. See more articles, interviews, and her blog at www.laurieedwardswriter.com.

Participatory Medicine, Chronic Illness, and

EMRs

Participatory medicine is a model of cooperative health care that seeks to achieve active involvement by patients, professionals, caregivers, and others across the continuum of care.1

E-patients are those who are “are equipped, enabled, empowered and engaged in their health and health care decisions.”2

Chronic illness affects 45 percent of the population and is responsible for 75 percent of annual health care spending. Treating the seven most common chronic diseases, coupled with productivity losses they entail, costs the U.S. economy more than $1 trillion annually.3

Many patients live with multiple chronic illnesses, and almost 30 million Americans live with 6,800 rare diseases, diseases that affect fewer than 200,000 people.4

EMRs and the Doctor-Patient Relationship

Over half of all physicians today use EMRs, due in part to federal incentives, but many have expressed dissatisfaction with how they interfere with face-to-face interaction with their patients.5

Unlike smart phones and tablets that use more intuitive, touch-screen technology, most EMRs are relatively outdated and more cumbersome. It takes over 50 mouse clicks and dozens of screens to input a straightforward office visit for a sinus infection, and over 10 clicks to refill an electronic prescription.6

 Time on-screen means time away from patient interaction: the American Journal of Emergency Medicine found that ED physicians spent 43% of their time entering data and only 28% of their time speaking with patients.7

The Digital Divide and EMR Adoption

The National Adult Literacy Survey suggests that nearly 50% of all adults have problems understanding many aspects of health care, including patient education materials and prescriptions.8

One in 5 US adults do not go online.9

Ninety million people have been classified with limited health literacy, and over the last three decades, the number of people in the U.S. who speak a language other than English has grown by 140 percent.10

Health IT barriers remain: A 2014 consumer engagement report found that minorities were less likely to access online patient portals than non-Hispanic whites.11

The Digital Divide, Continued

The Health and Human Services (HHS) Action Plan to Reduce Racial and Ethnic Health Disparities includes a focus on improving patient care by creating culturally and linguistically appropriate tools for health information exchange. 12

Hospitals have used the Internet and Intranet to provide patient education in multiple languages, including accommodations for those who are hard of hearing.13

Online translation tools only provide information in one direction, making it hard for providers to ascertain patient comprehension. Hospitals should consider supplementing these online materials with professional interpreters to help facilitate communication.14

Interoperability and Functionality

As with most technology we use, EMRs are not a “one size fits all” solution. Increasing interoperability of health information is a major goal of the Office of Standards and Interoperability at the U.S. Department of Health and Human Services. 15 

The Blue Button movement, now under the Office of the National Coordinator for Health Information Technology (ONC), speaks to an underlying theme at the center of participatory medicine and health IT: Let patients have their data.16

More than 450 organizations have embraced the Blue Button to make personal health information available to patients via multiple sources: healthcare providers, health insurance companies, labs, pharmacies, etc.17

Interoperability, Continued

In 2012, 33 percent of primary care physicians could exchange clinical summaries with other doctors, and 35 percent could share lab or diagnostic tests with doctors outside their practice.18

The big practice/small practice divide impacts patient engagement. While half of physicians in solo practices use EMRs, 90 percent of those in practices of 20 or more physicians do.19 Increased technical assistance and financial incentives increase EMR adoption and physician proficiency and trickles down to patient use and proficiency.

To overcome both the digital and training divide, EMRs with integrated, comprehensive patient portals and access to the best patient educational resources in these portals are critical.20

References

1. “Welcome,” http://e-patients.net/

2. “About Us,” http://e-patients.net/about-e-patientsnet

3. “About the Crisis,” http://fightchronicdisease.org/facing-issues/about-crisis

4. “Rare Disease Information,” http://rarediseases.org/rare-disease-information

5. Pho, Kevin. “Electronic Medical Records Obstruct Patient Interaction,” http://www.kevinmd.com/blog/2014/02/electronic-medical-records-obstruct-patient-interaction.html

6. Pho, Kevin. “Electronic Medical Records Obstruct Patient Interaction,” http://www.kevinmd.com/blog/2014/02/electronic-medical-records-obstruct-patient-interaction.html

7. Hill, et al. “4000 Clicks: A Productivity Analysis of Electronic Medical Records in a Community Hospital ED,” http://www.ajemjournal.com/article/S0735-6757%2813%2900405-1/abstract

8. “Meaningful Use and Patient Engagement: Supporting eHealth Literacy,” http://www.the-rheumatologist.org/details/article/1332913/Meaningful_Use_and_Patient_Engagement_-_Supporting_eHealth_Literacy.html

9. Fox, Susannah, and Maeve Duggan, “Information Triage,” http://www.pewinternet.org/2013/01/15/information-triage/

References, Continued

10. Tomsik, Elizabeth, and Bonnie Briggs, “Empowering Patients Through Advanced EMR Use,” http://www.healthmgttech.com/articles/201303/empowering-patients-through-advanced-emr-use.php

11. DeSalvo, Karen, MD and J. Nadine Gracia, MD, “Advancing Health Equity in the Digital Age,” http://thehealthcareblog.com/blog/2014/04/20/advancing-health-equity-in-the-digital-age/

12. DeSalvo, Karen, MD and J. Nadine Gracia, MD, “Advancing Health Equity in the Digital Age,” http://thehealthcareblog.com/blog/2014/04/20/advancing-health-equity-in-the-digital-age/

13. Wilson-Stronks, Amy, et al. “One Size Does Not Fit All: Meeting the Health Care Needs of Diverse Populations,” http://www.jointcommission.org/assets/1/6/HLCOneSizeFinal.pdf, 36.

14. Wilson-Stronks, Amy, et al. “One Size Does Not Fit All: Meeting the Health Care Needs of Diverse Populations,” http://www.jointcommission.org/assets/1/6/HLCOneSizeFinal.pdf, 37.

15. “Standards and Interoperability,” http://www.healthit.gov/providers-professionals/standards-interoperability

16. “The Blue Button Movement,” http://healthit.gov/patients-families/about-blue-button-movement

17. The Blue Button Movement,” http://healthit.gov/patients-families/about-blue-button-movement

18. Audet, Anne-Marie J., et al. “Where Are We on the Diffusion Curve? Trends and Drivers of Primary Care Physicians’ Use of Health Information Technology,” http://www.commonwealthfund.org/Publications/In-the-Literature/2014/Jan/Where-Are-We-on-the-Diffusion-Curve.aspx?omnicid=20

19. Audet, Anne-Marie J., et al. “Where Are We on the Diffusion Curve? Trends and Drivers of Primary Care Physicians’ Use of Health Information Technology,” http://www.commonwealthfund.org/Publications/In-the-Literature/2014/Jan/Where-Are-We-on-the-Diffusion-Curve.aspx?omnicid=20

20. Audet, Anne-Marie J., et al. “Where Are We on the Diffusion Curve? Trends and Drivers of Primary Care Physicians’ Use of Health Information Technology,” http://www.commonwealthfund.org/Publications/In-the-Literature/2014/Jan/Where-Are-We-on-the-Diffusion-Curve.aspx?omnicid=20