One hospital finds better communication with patients thanks to EHRs

Dealing with electronic health records (EHRs) and worrying about patient satisfaction are popular pastimes for many physicians. No one's ever content with either.

Thus, researchers said they were recently surprised to find that EHR implementation may actually improve patient satisfaction. In a study at the University of California Los Angeles (UCLA), more than 3,000 patients were surveyed about their perceptions of communication with the residents caring for them. Patients reported better communication in the period after EHRs were implemented, according to results published in the October 2014 Journal of Hospital Medicine.

Patients said residents were significantly more likely to introduce themselves, communicate about care plans, listen to questions, and be sensitive to physical and emotional needs, among other issues.

Study co-author Nasim Afsar-manesh, MD, FACP, recently spoke to ACP Hospitalist about the meaning of her findings. Dr. Afsar-manesh is a hospitalist, assistant clinical professor, and associate chief medical officer at UCLA Hospitals.

Q: Were you surprised by the study's results?

A: Our hypothesis was that our patient experience would be much worse after implementing an EHR. We were truly interested in the results of it.

Q: What led you to study this issue?

A: There has been a lot of discussion nationally as EHRs have rolled out, about the negative impact of this with the patient experience. UCLA now, for more than a decade, has been a leader in patient experience nationally…. We were very concerned as we rolled out our electronic health record in March 2013 of what would be the impact of this on our patient experience.

Q: How did you gather the patient satisfaction information?

A: We had been collecting data on the patient experience through volunteers we have in the hospital. We had data from before the implementation and after the implementation. We did the data analysis looking at a period of time several months before the go-live [date] and several months after the go-live and actually found that the results improved after implementation of our EHR. There wasn't any other thing that we were doing, like a patient experience campaign or anything at that time; the only thing that really changed was the EHR.

Q: Did your residents get any specific training on maintaining patient experience while using EHRs?

A: We actually have an extensive program training our residents around the patient experience … the CI-CARE platform, which was described in the paper. [CI-CARE is a protocol: Connect with patients, Introduce yourself, Communicate your purpose, Ask or anticipate patients' needs, Respond to questions with immediacy, Exit courteously.] The residents are educated on that, and then there is an annual kind of refresher that we all go through. That model is really aimed at—regardless of whether you have a computer or not—having the patient front and center of your focus.

There weren't things that were specific to now that you have an EHR, what do you do? It was more to make sure that the training that we had already emphasized and established continued to maintain the focus.

We do something which I think is quite unique … a group of volunteers go around and get patient satisfaction data on our residents on a weekly basis, and we share that with our residents, so they get feedback. If … because of the computer or because of increased volume or whatever reason, you have practices that negatively impact your patient experience, you would hear about it, because it comes out in the [weekly data].We didn't have to specifically do something for training, but the feedback mechanism and the accountability that we set up helps address that.

Q: How do you explain the improvement in patient satisfaction?

A: My major thinking is that [EHRs may have mitigated] certain inefficiencies that existed in our system. We are a very busy medical center, and it would not be uncommon for a medical resident as well as surgical residents to have patients in multiple units, to have to run up and down to be able to put in orders or to be able to communicate with nurses. The EHR really kind of took all that out. You could be sitting in one place putting everything in. It created increasing efficiencies. Considering that that hasn't translated into our housestaff leaving the hospital earlier—they're still working the same number of hours—my sense is that that's translating into them spending more time with patients and families.

Q: Many physicians express concern that EHRs impede interactions with patients. What lessons should they take from your study?

A: One of the great things about being a hospitalist is that you're not confined by the allotted amount of time for a patient visit.

If I had a 15-minute clinic visit, and I had to look up things in an electronic health record and get information from the patient, and also chart some of that information in the system, I could see that it could be challenging…. For other doctors, it's about how do you leverage the technology that you have to deliver the highest quality of care for your patients but also preserve that sacred physician-patient relationship? That's part of the art of medicine. There are people that do that and have phenomenal relationships with their patients and have great patient satisfaction scores.