Impact of a brief faculty training to improve patient-centered communication while using electronic health records

Highlights

• Few faculty are trained on patient-centered communication skills while using EHRs.

• A short lecture and OSCE is a feasible and effective way to train busy faculty.

• A positive impact on physician clinic room behavior was observed post-training.

• Faculty retained the patient-centered EHR use skills three months post-training.

Abstract

Objective

Despite rapid EHR adoption, few faculty receive training in how to implement patient-centered communication skills while using computers in exam rooms. We piloted a patient-centered EHR use training to address this issue.

Methods

Faculty received four hours of training at Cleveland Clinic and a condensed 90-minute version at the University of Chicago. Both included a lecture and a Group-Objective Structured Clinical Exam (GOSCE) experience. Direct observations of 10 faculty in their clinical practices were performed pre- and post-workshop.

Results

Thirty participants (94%) completed a post-workshop evaluation assessing knowledge, attitude, and skills. Faculty reported that training was important, relevant, and should be required for all providers; no differences were found between longer versus shorter training. Participants in the longer training reported higher GOSCE efficacy, however shorter workshop participants agreed more with the statement that they had gained new knowledge. Faculty improved their patient-centered EHR use skills in clinical practice on post- versus pre-workshop ratings using a validated direct-observation rating tool.

Conclusion

A brief lecture and GOSCE can be effective in training busy faculty on patient-centered EHR use skills.

Practice Implications

Faculty training on patient-centered EHR skills can enhance patient-doctor communication and promotes positive role modeling of these skills to learners.

Introduction

As clinicians increasingly integrate Electronic Health Records (EHRs) into clinical practice, it is important to consider the impact of EHR use on patient-doctor communication. While benefits of computerization in health care are well described, important drawbacks exist [1]. Some studies found that EHR use can prevent doctors from focusing on patients, impede communication, and be detrimental to the patient–doctor communication [[2], [3], [4], [5]]. When providers use the EHR, negative behaviors such as poor eye contact, prolonged screen gazing, and typing during sensitive discussions can emerge and have been found to undermine the patient-doctor relationship [6,7].

In the digital age, physicians need to be mindful of their “computer-side manner” as they adapt to accommodate the computer as the third party in the room. The reality of this situation is that physicians are managing competing demands as they try to remain focused on the patient while attending to the demands of the EHR. A recent study found that physicians spend 53% of their time on direct face to face care and 37% on EHR work and documentation while in the exam room [8]. One proposed strategy to address this issue of “distracted doctoring” is to integrate scribes or team based documentation assistants (e.g. Medical Assistants with expanded roles) into the clinical care team. While these interventions have shown promise for improving patient-doctor communication by minimizing EHR distraction, hiring scribes or expanding the role of existing team members may not be financially or logistically feasible for resource–tight academic practices [[9], [10], [11]]. In addition, other studies have looked at strategies to improve patient-doctor-EHR communication through enhanced exam room layouts, workflow improvements, and the use of decision aids, all with mixed results [12,13].

An alternate approach to improve patient-doctor-EHR communication may be to train physicians to utilize patient-centered communication skills. Studies have found that implementing patient-centered communication strategies can improve patient satisfaction and understanding, in addition to adherence to treatment and cost utilization [14]. Integrating patient-centered strategies may allow the EHR to be used as a tool to engage patients in meaningful discussions, enhance the therapeutic relationship and positively impact patient outcomes [[15], [16], [17], [18]]. Several communication behaviors have been found to promote patient-centered communication when EHRs are used in the exam room. Specific behaviors include: screen sharing; starting the visit technology free; maximizing eye contact; disengaging with the EHR during sensitive discussions, and using the EHR for patient education and shared decision making [16,[19], [20], [21], [22], [23], [24], [25], [26], [27]]. In recent years, medical educators have called for curricula to teach these EHR-related communication skills and some have emerged for students and residents [[28], [29], [30]].

Despite the existence of best practices and calls for enhanced training on this topic, few faculty receive formal training on these key patient-centered EHR communication behaviors. As a result, they may be ill equipped to teach trainees [19,20,23,29,[31], [32], [33]]. To address this gap an, we piloted a Patient-Centered EHR Use training for primary care faculty at two academic institutions: The University of Chicago (UC) and The Cleveland Clinic (CC).