Patients attending a safety-net primary care clinic in Seattle were interested and able to type their agenda into the electronic health record (EHR) visit note, and as a result, both patients and clinicians felt improved communication, according to new research in the Annals of Family Medicine.
More than 100 patients and clinicians at Seattle’s Harborview Medical Center (HMC) participated in the study, which took place in 2015. As the researchers stated, “existing OpenNotes research shows enthusiasm among both patients and clinicians, but this is the first Open-Notes study of cogeneration of clinic notes. Allowing patients to type their agenda into their clinic note before a visit may facilitate communication of health concerns,” they said.
For the study, researchers assessed the feasibility, acceptability, and utility of patients at the clinic typing their agendas into the electronic visit note before seeing their clinicians. Specifically, a research assistant met with patients in the waiting room, provided them with a laptop with the clinic’s EHR interface, and let them type their agenda. The patient typed the agenda in the clinician’s “progress notes” field under the research assistant’s name with the heading, “The following was typed by the patient as part of a pilot study on patient written visit agendas.” Participating clinicians reviewed the agenda before or upon entering the patient’s exam room, and the patient’s agenda remained in the notes section of the permanent visit record, adjacent to the physician’s note, in the EHR.
In the end, patients and clinicians agreed that the agendas improved patient-clinician communication (patients 79 percent, clinician 74 percent), and wanted to continue having patients type agendas in the future (73 percent; 82 percent). Enabling patients to type visit agendas may enhance care by engaging patients and giving clinicians an efficient way to prioritize patients’ concerns, noted the researchers.
They stated that clinicians often cite inadequate visit time as a barrier to relationship development and communication with patients. Interacting with EHRs during patient interviews has also eroded clinicians’ ability to connect with patients8 and led to clinician dissatisfaction with clinical practice, particularly in primary care, the researchers said. “This pilot study suggests a possible way for the EHR to offset the time and computer barriers to communication. By allowing patients to set agendas before appointments, patients and clinicians can optimize their time together.”