Patients Typing Their Own Visit Agendas Into an Electronic Medical Record: Pilot in a Safety-Net Clinic

I'd like to express my thanks to Anderson et al[1] for experimenting with agenda setting by patients using an electronic medical record (EMR) link prior to the visit. Anything we can do to help the patient and health care team organize the visit helps all involved make the best use of time. When I first published an agenda setting study[2], also done with a University of Washington Medical student (LH), we only trained physicians. Eventually it became obvious to go upstream and train medical assistants to begin agenda setting to promote time management and to expand options for multiple members of the health care team to be involved earlier in the patient flow. As the EMR became the dominant form of record keeping, the vision of having patients start the process before the visit became realistic. Anderson el are helping create the foundation for what will be a growing list of studies exploring ways to share visit planning with patients to improve the quality and efficiency of care.

Additional elements to add to the pre-visit agenda setting process that promise to help with quality and efficiency include asking patients to prioritize concerns, indicate if they need refills and indicate if they have paperwork to fill out.

In 2003, some colleagues and I published a study[3] of a low income, uninsured primary care population where we asked patients to indicate before the visit what they hoped to address with their primary care provider but did not share this list with the provider. We also asked providers to indicate what problems they elicited from patients. We found some discrepancies in prevalence and priority. For example, 29 percent of patients indicated they wanted to talk about "problem's with mood" but providers reported that only 9.8 percent of patients mentioned this as a concern. Eight percent of patients wanted to talk about tobacco dependence but providers reported that only one percent of patients indicated this concern. Future research will need to examine how use of the EHR for agenda setting combined with provider, medical assistant and receptionist training influences patient openness, the prioritization process between the health care team and the patient, and health outcomes.

References
1. Anderson MO, Jackson SL, Oster NV, et al. Patients Typing Their Own Visit Agendas Into an Electronic Medical Record: Pilot in a Safety-Net Clinic. Ann Fam Med. 2017;15(2):158-161.
2. Mauksch LB, Hillenburg L, Robins L. The established focus protocol: training for collaborative agenda setting and time management in the medical interview. Families, Systems and Health. 2001;19(2):147-157.
3. Mauksch LB, Katon WJ, Russo J, Tucker SM, Walker E, Cameron J. The content of a low-income, uninsured primary care population: including the patient agenda. J Am Board Fam Pract. 2003;16(4):278-289.

Competing interests: I receive fees for consultation to educational and health care organizations