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

McHale O. Anderson; Sara L. Jackson; Natalia V. Oster; Sue Peacock; Janice D. Walker; Galen Y. Chen; Joann G. Elmore

doi:10.1370/afm.2036

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Figure 1
Patient (N = 101) and clinician (N = 27) perceptions of patient-written agendas.^a
^aSurvey items for patients: “Because of writing my visit agenda, my doctor: (1) seemed more prepared for my visit than usual, (2) Had a better understanding of my health concerns than usual”; “Writing my visit agenda: (1) made this visit more efficient, (2) helped me prioritize my health concerns, (3) improved communication between me and my doctor”; “I would like to type the reasons for my visit before my appointments in the future.”
Survey items for clinicians: “When my patients typed their visit agenda, this: (1) made me better prepared for my patients’ visits than usual, (2) helped me prioritize my patients’ concerns, (3) helped me utilize my time more efficiently during my appointments, (4) improved communication with my patients”; “Overall, I would like for my patients to type visit agendas in the future.”
^bLikert scale responses were collapsed into binary categories (“agree” + “strongly agree” = “yes”) to simplify presentation.

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Table 1

Characteristics of Patients, Clinicians, and Visit Agendas

Patient Characteristic (n = 101)	N (%)
Age
18–49	28 (28%)
50–59	31 (31%)
60–69	33 (33%)
≥70	9 (9%)
Sex
Male	57 (56%)
Female	44 (44%)
Education
High school or less	32 (32%)
Some college	44 (44%)
4 year college degree or more	25 (25%)
Race
White	56 (55%)
Black	31 (31%)
Multi-racial/other	14 (14%)
Employment^a
Employed/self-employed/homemaker	28 (28%)
Retired	32 (32%)
Unemployed/unable to work	40 (40%)
Self-reported health
Poor	9 (9%)
Fair	23 (23%)
Good	42 (42%)
Very good	22 (22%)
Excellent	5 (5%)
Patient diagnosis^b
Pain	36 (36%)
Diabetes	31 (31%)
HTN	30 (30%)
Depression	18 (18%)
Anxiety/Panic	12 (12%)
Clinician-documented level of service (evaluation and management codes)^a,^c
2	1 (1%)
3	34 (34%)
4	56 (56%)
5	8 (8%)
Clinician Characteristics (N = 27)	N (%)

Age (years)
<40	18 (67%)
≥40	9 (33%)
Sex
Male	6 (22%)
Female	21 (78%)
Role
Teaching attending physicians/advanced registered nurse practitioners	13 (48%)
Residents	14 (52%)
Agenda characteristics (N = 101)	N (%)

Time (in minutes) to type agenda
<5	39 (40%)
5–9	42 (43%)
≥10	16 (16%)
Number of words typed
<15	21 (21%)
15–29	30 (30%)
30–59	29 (29%)
≥60	21 (21%)

↵a One respondent did not provide employment information. Level of service was unattainable for 2 respondents due to technical issues. Data on time to type agenda was not available for 4 patients.
↵b Most common diagnoses; could have more than 1 diagnosis per visit.
↵c Evaluation and management codes range from low complexity visit (Level 2) to high complexity (Level 5).

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Table 2

Example of a Patient-Typed Agenda and Clinician Comment; Examples of Patients’ and Clinicians’ Responses from the Follow-Up Survey

A. Example of Patient-Typed Agenda and Clinician Response

Patient-typed agenda:

“1. Lumps on my lungs
2. my ankle is not getting better
3. the boot is giving me knee problems”

Clinician’s comments on the above patient-typed agenda:

“My patient typed ‘lumps on lungs’. This was a pulmonary nodule identified on a CT scan in the ER that I might have missed if he had not put it on his agenda. While the nodule was incidental, the patient was anxious about the finding and I was able to provide reassurance.”

B. Examples of Patients’ and Clinicians’ Responses from the Follow-up Survey

Patients’ comments from the follow-up survey
• “Helps me remember what I am being seen for”
• “Gave doctor my information so I wouldn’t be nervous and forget”
• “Doctor and I on same page”
• “Made me think about reasons for visit before seeing doctor”
• “New doctor so this was excellent way of getting my feelings across”

Clinicians’ comments from the follow-up survey

• “Got time to think about issues ahead of time”
• “Engaged patient to participate more in the visit, he felt ‘heard’”

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The Article in Brief

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

Joann G. Elmore , and colleagues

Background Electronic medical records offer patients access to their medical data, including doctors' notes, and can facilitate increased patient involvement in their health care and contributions to their health data

What This Study Found Allowing patients to type their visit agenda into their electronic medical record before an office visit appears to facilitate communication of health concerns. Among 101 patients who typed their agenda into the electronic medical record visit note and their 28 clinicians, both patients and clinicians felt the agendas improved patient-clinician communication. Both expressed a desire to continue having patients type agendas in the future. The agendas themselves were brief; 83 percent of patients typed for less than 10 minutes, and 79 percent typed less than 60 words.

Implications

Enabling patients to type visit agendas may enhance care by engaging patients, increasing the collaborative nature of the clinical encounter, and giving clinicians an efficient way to prioritize patients' concerns and optimize their time together.