School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, NJ, 07047, USA.
Collaborative for Healthcare Delivery Science, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, USA.
Int J Med Inform. 2021 Feb;146:104345. doi: 10.1016/j.ijmedinf.2020.104345. Epub 2020 Nov 17.
Patients and physicians engaging together in the electronic health record (EHR) during clinical visits may provide opportunities to both improve patient understanding and reduce medical errors.
To assess the potential impact of a patient EHR display intervention on patient quality and safety. We hypothesized that if patients had a dedicated display with an explicit invitation to follow clinicians in the EHR that this would identify several opportunities to engage patients in their care quality and safety.
Physician-patient outpatient encounters (24 patients and 8 physicians) were videotaped. Encounters took place in a hospital-based general internal medicine outpatient clinic where physicians and patients had their respective EHR monitors. Following the visits, each patient and physician was interviewed for 30 min to understand their perception of the mirrored-screen setting.
The following 7 themes were identified (a) curiosity, (b) opportunity to ask questions, (c) error identification, (d) control over medications, (e) awareness, (f) shared understanding & decision-making, (g) data privacy. These themes collectively comprised a conceptual model for how patient engagement in electronic health record use, through a dedicated second screen or an explicitly shared screen, relates to safety and quality opportunities. Therefore, the double EHR screen provides an explicit invitation for patients to join the process to influence safety.
Desired outcomes include real-time error identification and better-shared understanding and decision-making, leading to better downstream follow-through with care plans.
患者和医生在临床就诊时共同使用电子健康记录（EHR），这可能为改善患者的理解能力和减少医疗差错提供机会。
评估患者 EHR 显示干预对患者质量和安全的潜在影响。我们假设，如果患者有一个专门的显示器，并明确邀请他们跟随医生在 EHR 中查看，这将为患者参与其护理质量和安全提供几个机会。
对医生-患者的门诊就诊（24 名患者和 8 名医生）进行了录像。就诊在一家以医院为基础的普通内科门诊进行，医生和患者都有各自的 EHR 显示器。就诊结束后，对每位患者和医生进行了 30 分钟的访谈，以了解他们对镜像屏幕设置的看法。
确定了以下 7 个主题：（a）好奇心，（b）提问机会，（c）错误识别，（d）药物控制，（e）意识，（f）共同理解和决策制定，（g）数据隐私。这些主题共同构成了一个概念模型，说明患者如何通过专用的第二屏幕或明确共享的屏幕参与电子健康记录的使用，与安全和质量机会相关。因此，双 EHR 屏幕为患者提供了明确的邀请，加入到这个过程中，以影响安全性。
预期的结果包括实时错误识别以及更好的共同理解和决策制定，从而更好地遵循护理计划。
