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HSR&D 2004 National Meeting Abstracts

1016. Does the Use of Electronic Medical Records Enhance Patient-Centered Care?
Nedal H Arar, MS, MA, PhD, VERDICT, VA HSR&D Center of Excellence, South Texas Veterans Healthcare System, J Rosales, VERDICT, VA HSR&D Center of Excellence, South Texas Veterans Healthcare System, J Pugh, VERDICT, VA HSR&D Center of Excellence, South Texas Veterans Healthcare System

Objectives: Electronic medical record (EMR) systems, as part of the clinical information system, have potential for improving the performance of the clinical micro-systems that form the base for patient-provider interactions. Our objective is to examine the impact of EMR use on patient-centered care (PCC) during outpatient primary care encounters.

Methods: A cross-sectional, observational study design combining qualitative and quantitative approaches was employed. Fifty VA general internal medicine clinic encounters were videotaped with 6 physicians who had access to EMR systems in 2000. The average number of observed patients per provider was 8 (range: 3-12, SD=3.2). PCC is defined as shared control of health care management decisions between patients and their physicians during encounters. Shared control was represented by encounter scores derived from Greenfield’s formula, whereby scores closest to 1 corresponded with a higher degree of patient-centeredness.

Results: All encounters were physician-controlled (average score=0.28, SD=0.31). However, encounters where the physician used the EMR for more than 10% of the encounter time were more patient-centered (t-test, p=0.07). The triangulation of the qualitative and quantitative data showed that the use of the EMR during encounters may shift the system towards patient-centeredness. The EMR condition encouraged patients to participate and become more involved in the encounter. Using the Contextual Assessment Framework, we contrasted patient and provider concepts and explanations of illnesses, and considered the improvement of communications within the dynamic process of clinical interactions.

Conclusions: Providers’ use of EMR may enhance patient-centeredness by improving contextual exchange between patients and physicians regarding disease management during interactions.

Impact: Improvement in quality of outpatient care may be achieved by optimizing the use of EMR to enhance patient-provider communications.