Asan Onur, Tyszka Jeanne, Crotty Bradley
Division of General Internal Medicine, Department of Medicine, Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
JAMIA Open. 2018 Apr 20;1(1):42-48. doi: 10.1093/jamiaopen/ooy006. eCollection 2018 Jul.
Electronic health records (EHRs) in physician offices can both enhance and detract from the patient experience. Best practices have emerged focusing on screen sharing. We sought to determine if adding a second monitor, mirroring the EHR for patients, would be welcome and useful for patients and clinicians.
This mixed-method study was conducted in a general medicine clinic from March to June 2016. Clinicians and patients met in a specially equipped exam room with a patient-facing monitor. Visits were video-recorded to assess time spent viewing the EHR and followed by interviews, which were transcribed and analyzed using established qualitative methods.
Eight clinicians and 24 patients participated. Main themes included the second screen serving as a catalyst for patient engagement, augmenting the clinic visit in a meaningful way, improving transparency of the care process and documentation, and providing a substantially different experience for patients than a shared single screen. Concerns and suggestions for improvement were also reported. Quantitative results showed high patient engagement times with the EHR (25% of the visit length) compared to reports in previous studies. The median satisfaction score was 5 out of 5 for patients and 3.3 out of 5 for clinicians.
Providing patient access to the EHRs with this design was linked with several benefits including improved patient engagement, education, transparency, comprehension, and trust. Future studies should explore how best to display information in such screens for patients and identify impact on care, safety, and quality.
医生办公室的电子健康记录（EHRs）既能提升也可能损害患者体验。已出现聚焦于屏幕共享的最佳实践方法。我们试图确定为患者增加一个镜像EHR的第二台显示器是否会受到患者和临床医生的欢迎并对他们有用。
这项混合方法研究于2016年3月至6月在一家普通内科诊所进行。临床医生和患者在一个配备了面向患者显示器的特殊检查室会面。就诊过程进行了视频录制，以评估查看EHR所花费的时间，随后进行访谈，并使用既定的定性方法对访谈内容进行转录和分析。
8名临床医生和24名患者参与了研究。主要主题包括第二块屏幕成为促进患者参与的催化剂，以有意义的方式增强门诊就诊体验，提高护理过程和文档记录的透明度，以及为患者提供与共享单屏幕截然不同的体验。研究还报告了相关担忧和改进建议。定量结果显示，与之前研究报告相比，患者查看EHR的参与时间较长（占就诊时长的25%）。患者的满意度中位数评分为5分（满分5分），临床医生为3.3分（满分5分）。
采用这种设计让患者访问EHRs带来了多项益处，包括提高患者参与度、教育效果、透明度、理解度和信任度。未来的研究应探索如何在这类屏幕上以最佳方式为患者展示信息，并确定其对护理、安全和质量的影响。
