Delivering person-centered care with an electronic health record

Victoria Stanhope, Elizabeth B Matthews, Victoria Stanhope, Elizabeth B Matthews

Abstract

Background: Electronic health records are now widely adopted in medical and behavioral health settings. While they have the potential to improve the quality of care, the research findings on their impact on clinical practice and outcomes have been mixed. This study explores how the electronic health record and its stage of development influenced the implementation of person-centered care planning in community mental health clinics.

Methods: The study was set in five community mental health clinics which utilized an EHR and had been trained in person-centered care planning. Using an objective quantitative measure of fidelity, the study examined fidelity to PCCP across time and by stage of EHR development. Data from focus groups, interviews with clinic leaders and consultant reports was analyzed to explore the process of implementation and the role of the electronic health record.

Results: All clinics demonstrated an overall increase in PCCP fidelity at the conclusion of the study period but there were significant differences in PCCP fidelity among clinics with EHRs in different stages of development. Electronic health records emerged as a significant implementation factor in the qualitative data with clinics being unable to individualize service plans and encountering technical difficulties. Barriers to person-centered care included drop-down boxes and pre-determined outcomes. Clinic responses included customizing their record or developing workarounds.

Conclusions: The study demonstrated the need to align the electronic health record with a person-centered approach which includes individualizing information and orienting service plans to personal life goals. The ability of clinics to be able to customize their records and balance the need for unique and aggregate information in the record is critical to improve both the provider experience and the quality of care.

Trial registration: Clinicaltrials.gov , NCT02299492 , registered on November 24, 2014.

Keywords: Electronic health records; Health information technology; Mental health services; Person-centered care.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PCCP Fidelity by EHR Development Stage. The figure shows PCCP fidelity score (range 1–13) at baseline, 12 months and 18 months by three EHR development stages at baseline, 12 month and 18 months

References

    1. Riahi S, Fischler I, Stuckey MI, Klassen PE, Chen J. The Value of Electronic Medical Record Implementation in Mental Health Care: A Case Study. JMIR Med Inform. 2017;5(1):e1-e. doi: 10.2196/medinform.6512.
    1. Institute of Medicine . Crossing the quality chasm: a new health system for the 21st century. The brief report. Washington, DC: National Academies Press; 2001.
    1. Cifuentes M, Davis M, Fernald D, Gunn R, Dickinson P, Cohen DJ. Electronic health record challenges, workarounds, and solutions observed in practices integrating behavioral health and primary care. J Am Board Fam Med. 2015;28(Supplement 1):S63. doi: 10.3122/jabfm.2015.S1.150133.
    1. Buntin MB, Burke MF, Hoaglin MC, Blumenthal D. The benefits of health information technology: a review of the recent literature shows predominantly positive results. Health Aff. 2011;30(3):464–471. doi: 10.1377/hlthaff.2011.0178.
    1. Jie Mein G, Guodong G, Agarwal R. Evolving work routines: adaptive routinization of information Technology in Healthcare. Inf Syst Res. 2011;22(3):565–585. doi: 10.1287/isre.1110.0365.
    1. Health NCfB . HIT adoption and readiness for meaningful use in community behavioral health: report on the 2012 national council survey. Washington, DC: National Council on Behavioral Health; 2012.
    1. Gerrity M, Zoller E, Pinson N, Pettinari C, King V. Integrating primary care into behavioral health settings: what works for individuals with serious mental illness. New York, NY: Millbank Memorial Fund; 2014.
    1. Young AS, Cohen AN, Chang ET, Flynn AWP, Hamilton AB, Oberman R, et al. A clustered controlled trial of the implementation and effectiveness of a medical home to improve health care of people with serious mental illness: study protocol. BMC Health Serv Res. 2018;18(1):428. doi: 10.1186/s12913-018-3237-0.
    1. Kern LM, Edwards A, Kaushal R. The patient-centered medical home, electronic health records, and quality of CarePatient-centered medical home and quality of care. Ann Intern Med. 2014;160(11):741–749. doi: 10.7326/M13-1798.
    1. Stange KC, Nutting PA, Miller WL, Jaen CR, Crabtree BF, Flocke SA, et al. Defining and measuring the patient-centered medical home. J Gen Intern Med. 2010;25(6):601–612. doi: 10.1007/s11606-010-1291-3.
    1. Department of Health and Human Services. New Freedom Commission on Mental Health: Achieving the promise: Transforming mental health care in America. Final report. Rockville, MD: Author; 2003. Report No.: DHHS pub no SMA-03–3832.
    1. Davidson L, O'Connell MJ, Tondora J, Lawless M, Evans AC. Recovery in serious mental illness: a new wine or just a new bottle. Prof Psychol Res Pract. 2005;36:480–487. doi: 10.1037/0735-7028.36.5.480.
    1. Adams Neal, Grieder Diane M. Treatment Planning for Person-Centered Care. 2014. The Health Care Landscape; pp. 3–35.
    1. Tondora J, Miller R, Slade M, Davidson L. Partnering for recovery in mental health: a practical guide to person-centered planning. Hoboken: Wiley; 2014.
    1. Burke HB, Sessums LL, Hoang A, Magee C, Becher DA, Pangaro LN, et al. Electronic health records improve clinical note quality. J Am Med Inform Assoc. 2014;22(1):199–205.
    1. De Marinis MG, Piredda M, Pascarella MC, Vincenzi B, Spiga F, Tartaglini D, et al. ‘If it is not recorded, it has not been done!’? Consistency between nursing records and observed nursing care in an Italian hospital. J Clin Nurs. 2010;19(11–12):1544–1552. doi: 10.1111/j.1365-2702.2009.03012.x.
    1. Broderick MC, Coffey A. Person-centred care in nursing documentation. Int J Older People Nursing. 2013;8(4):309–318. doi: 10.1111/opn.12012.
    1. Kobus AM, Harman JS, Do HD, Garvin RD. Challenges to depression care documentation in an EHR. Fam Med. 2013;45(4):268–271.
    1. Triplett P. Psychiatry and the meaningful use of electronic health records. Perspect Biol Med. 2013;56(3):407–421. doi: 10.1353/pbm.2013.0028.
    1. Baumann LA, Baker J, Elshaug AG. The impact of electronic health record systems on clinical documentation times: a systematic review. Health Policy. 2018;122(8):827–836. doi: 10.1016/j.healthpol.2018.05.014.
    1. Garrido T, Jamieson L, Zhou Y, Wiesenthal A, Liang L. Effect of electronic health records in ambulatory care: retrospective, serial, cross sectional study. BMJ (Clinical research ed) 2005;330(7491):581. doi: 10.1136/bmj.330.7491.581.
    1. King J, Patel V, Jamoom EW, Furukawa MF. Clinical benefits of electronic health record use: national findings. Health Serv Res. 2014;49(1):392–404. doi: 10.1111/1475-6773.12135.
    1. Finkelstein JF, Knight A, Marinopoulos S, Gibbons M, Berger Z, Aboumatar H, et al. Enabling patient-centered care through health information technology. Rockville, MD: Agency for Healthcare Research and Quality; 2012. p. 206.
    1. Birks M, Chapman Y, Francis K. Memoing in qualitative research: probing data and processes. J Res Nurs. 2008;13(1):68–75. doi: 10.1177/1744987107081254.
    1. Glaser BG, Strauss AL, Strutzel E. The discovery of grounded theory; strategies for qualitative research. Nurs Res. 1968;17(4):364. doi: 10.1097/00006199-196807000-00014.
    1. Padgett DK. Qualitative methods in social work research. Second. Thousand Oaks, CA: Sage; 2008.
    1. Häyrinen K, Saranto K, Nykänen P. Definition, structure, content, use and impacts of electronic health records: a review of the research literature. Int J Med Inform. 2008;77(5):291–304. doi: 10.1016/j.ijmedinf.2007.09.001.
    1. Ferneley E, Sobreperez P. Resist, comply or workaround? An examination of different facets of user engagement with information systems AU - Ferneley, Elaine H. Eur J Inf Syst. 2006;15(4):345–356. doi: 10.1057/palgrave.ejis.3000629.
    1. Kawamoto K, Anstrom KJ, Anderson JB, Bosworth HB, Lobach DF, McAdam-Marx C, et al. Long-term impact of an electronic health record-enabled, team-based, and scalable population health strategy based on the chronic care model. AMIA Annu Symp Proc. 2016;2016:686–695.
    1. Gawande A. Annals of medicine: why doctors hate their computers. The New Yorker 2018 November 12.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera