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Butler JM, Gibson B, Lewis L, Reiber G, Kramer H, Rupper R, Herout J, Long B, Massaro D, Nebeker J. Patient-centered care and the electronic health record: exploring functionality and gaps. JAMIA Open 2020; 3:360-368. [PMID: 33215071 DOI: 10.1093/jamiaopen/ooaa044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/21/2020] [Accepted: 09/10/2020] [Indexed: 12/13/2022] Open
Abstract
Objective Healthcare systems have adopted electronic health records (EHRs) to support clinical care. Providing patient-centered care (PCC) is a goal of many healthcare systems. In this study, we sought to explore how existing EHR systems support PCC; defined as understanding the patient as a whole person, building relational connections between the clinician and patient, and supporting patients in health self-management. Materials and Methods We assessed availability of EHR functions consistent with providing PCC including patient goals and preferences, integrated care plans, and contextual and patient-generated data. We surveyed and then interviewed technical representatives and expert clinical users of 6 leading EHR systems. Questions focused on the availability of specific data and functions related to PCC (for technical representatives) and the clinical usefulness of PCC functions (for clinicians) in their EHR. Results Technical representatives (n = 6) reported that patient communication preferences, personalized indications for medications, and end of life preferences were functions implemented across 6 systems. Clinician users (n = 10) reported moderate usefulness of PCC functions (medians of 2-4 on a 5-pointy -35t scale), suggesting the potential for improvement across systems. Interviews revealed that clinicians do not have a shared conception of PCC. In many cases, data needed to deliver PCC was available in the EHR only in unstructured form. Data systems and functionality to support PCC are under development in these EHRs. Discussion and Conclusion There are current gaps in PCC functionality in EHRs and opportunities to support the practice of PCC through EHR redesign.
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Affiliation(s)
- Jorie M Butler
- Geriatric Research and Clinical Center (GRECC), George E. Wahlen Veteran Affairs Medical Center, Salt Lake City, Utah, USA.,Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah, USA.,Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Bryan Gibson
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Lacey Lewis
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah, USA
| | - Gayle Reiber
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, Utah, USA
| | - Heidi Kramer
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Rand Rupper
- Geriatric Research and Clinical Center (GRECC), George E. Wahlen Veteran Affairs Medical Center, Salt Lake City, Utah, USA.,Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Jennifer Herout
- Department of Veterans Affairs Office of Health Informatics, Washington, District of Columbia, USA
| | - Brenna Long
- Department of Veterans Affairs Office of Health Informatics, Washington, District of Columbia, USA
| | - David Massaro
- Department of Veterans Affairs Office of Health Informatics, Washington, District of Columbia, USA
| | - Jonathan Nebeker
- Geriatric Research and Clinical Center (GRECC), George E. Wahlen Veteran Affairs Medical Center, Salt Lake City, Utah, USA.,Division of Geriatrics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA.,Department of Veterans Affairs Office of Health Informatics, Washington, District of Columbia, USA
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Ahluwalia SC, Friedman E, Siconolfi D, Saliba D, Phillips J, Shih R. Promises and Pitfalls of Health Information Technology for Home- and Community-Based Services. J Appl Gerontol 2020; 40:558-565. [PMID: 32723124 DOI: 10.1177/0733464820941364] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Health information technology (HIT) use in home- and community-based services (HCBS) has been hindered by inadequate resources and incentives to support modernization. We sought to understand the ways the Medicaid Balancing Incentive Program (BIP) facilitated increased use of HIT to increase access to HCBS. Method: Qualitative analysis of interviews with 30 Medicaid administrators, service agency providers, and consumer advocates. Results: Although stakeholders perceived several benefits to greater HIT use, they highlighted critical challenges to effective adoption within the long-term services and supports (LTSS) system, including lack of extant expertise/knowledge about HIT, the limited reach of HIT among rural and disabled beneficiaries, burdensome procurement processes, and the ongoing resources required to maintain up-to-date HIT solutions. Conclusion: The structural reforms required by BIP gave states an opportunity to modernize their HCBS systems through use of HIT. However, barriers to HIT adoption persist, underscoring the need for continued support as part of future rebalancing efforts.
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Saillour-Glénisson F, Duhamel S, Fourneyron E, Huiart L, Joseph JP, Langlois E, Pincemail S, Ramel V, Renaud T, Roberts T, Sibé M, Thiessard F, Wittwer J, Salmi LR. Protocole of a controlled before-after evaluation of a national health information technology-based program to improve healthcare coordination and access to information. BMC Health Serv Res 2017; 17:297. [PMID: 28431579 PMCID: PMC5399879 DOI: 10.1186/s12913-017-2199-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 03/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improvement of coordination of all health and social care actors in the patient pathways is an important issue in many countries. Health Information (HI) technology has been considered as a potentially effective answer to this issue. The French Health Ministry first funded the development of five TSN ("Territoire de Soins Numérique"/Digital health territories) projects, aiming at improving healthcare coordination and access to information for healthcare providers, patients and the population, and at improving healthcare professionals work organization. The French Health Ministry then launched a call for grant to fund one research project consisting in evaluating the TSN projects implementation and impact and in developing a model for HI technology evaluation. METHODS EvaTSN is mainly based on a controlled before-after study design. Data collection covers three periods: before TSN program implementation, during early TSN program implementation and at late TSN program implementation, in the five TSN projects' territories and in five comparison territories. Three populations will be considered: "TSN-targeted people" (healthcare system users and people having characteristics targeted by the TSN projects), "TSN patient users" (people included in TSN experimentations or using particular services) and "TSN professional users" (healthcare professionals involved in TSN projects). Several samples will be made in each population depending on the objective, axis and stage of the study. Four types of data sources are considered: 1) extractions from the French National Heath Insurance Database (SNIIRAM) and the French Autonomy Personalized Allowance database, 2) Ad hoc surveys collecting information on knowledge of TSN projects, TSN program use, ease of use, satisfaction and understanding, TSN pathway experience and appropriateness of hospital admissions, 3) qualitative analyses using semi-directive interviews and focus groups and document analyses and 4) extractions of TSN implementation indicators from TSN program database. DISCUSSION EvaTSN is a challenging French national project for the production of evidenced-based information on HI technologies impact and on the context and conditions of their effectiveness and efficiency. We will be able to support health care management in order to implement HI technologies. We will also be able to produce an evaluation toolkit for HI technology evaluation. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT02837406 , 08/18/2016.
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Affiliation(s)
- Florence Saillour-Glénisson
- ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, University Bordeaux, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
- CHU de Bordeaux, Pôle de Santé Publique, Service d’Information Médicale, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
| | - Sylvie Duhamel
- Département de Médecine Générale, Université de Bordeaux, 146, rue Léo Saignat 33076, Bordeaux, Cedex France
| | - Emmanuelle Fourneyron
- Institut de Santé Publique d’Epidémiologie et de Développement, Université de Bordeaux, 146, rue Léo Saignat 33076, Cedex F-33000 Bordeaux, France
| | - Laetitia Huiart
- CHU, Unité de Soutien Méthodologique, Saint-Denis, F-97400 France
- Groupe Hospitalier Est Réunion, Route Nationale 3 30, 97470, Saint-Benoît-de-Carmaux, France
| | - Jean Philippe Joseph
- Département de Médecine Générale, Université de Bordeaux, 146, rue Léo Saignat 33076, Bordeaux, Cedex France
| | - Emmanuel Langlois
- University Bordeaux/Sciences Po Bordeaux, Centre Emile Durkheim, F-33000 Bordeaux, France
- Centre Emile Durkheim, Science Politique et Sociologie Comparatives, Université de Bordeaux, 3Ter, Place de la Victoire 33076, Bordeaux, Cedex France
| | - Stephane Pincemail
- Institut de Santé Publique d’Epidémiologie et de Développement, Université de Bordeaux, 146, rue Léo Saignat 33076, Cedex F-33000 Bordeaux, France
| | - Viviane Ramel
- ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, University Bordeaux, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
| | - Thomas Renaud
- ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, University Bordeaux, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
| | - Tamara Roberts
- Département de Médecine Générale, Université de Bordeaux, 146, rue Léo Saignat 33076, Bordeaux, Cedex France
- University Bordeaux/Sciences Po Bordeaux, Centre Emile Durkheim, F-33000 Bordeaux, France
| | - Matthieu Sibé
- ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, University Bordeaux, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
| | - Frantz Thiessard
- ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, University Bordeaux, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
| | - Jerome Wittwer
- ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, University Bordeaux, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
| | - Louis Rachid Salmi
- ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, University Bordeaux, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
- CHU de Bordeaux, Pôle de Santé Publique, Service d’Information Médicale, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
| | - for the EvaTSN Research group
- ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, University Bordeaux, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
- INSERM, ISPED, Centre INSERM U1219 Bordeaux Population Health Research Center, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
- CHU de Bordeaux, Pôle de Santé Publique, Service d’Information Médicale, 146 rue Léo Saignat, 33076, F-33000 Bordeaux, France
- Département de Médecine Générale, Université de Bordeaux, 146, rue Léo Saignat 33076, Bordeaux, Cedex France
- Institut de Santé Publique d’Epidémiologie et de Développement, Université de Bordeaux, 146, rue Léo Saignat 33076, Cedex F-33000 Bordeaux, France
- CHU, Unité de Soutien Méthodologique, Saint-Denis, F-97400 France
- University Bordeaux/Sciences Po Bordeaux, Centre Emile Durkheim, F-33000 Bordeaux, France
- Groupe Hospitalier Est Réunion, Route Nationale 3 30, 97470, Saint-Benoît-de-Carmaux, France
- Centre Emile Durkheim, Science Politique et Sociologie Comparatives, Université de Bordeaux, 3Ter, Place de la Victoire 33076, Bordeaux, Cedex France
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