Lost in Translation PLEASE SEAT YOURSELF BY BRAND OF ELECTRONIC HEALTH RECORD

Lost in Translation Examining the Impact of Electronic Health Records on Family Systems and Biopsychosocial Integration Anu Kotay, PhD; Eliana Korin, Dipl Psy; William Jordan, MD, MPH; Mary Duggan, MD

Objectives Identify challenges and opportunities presented by EHRs regarding biopsychosocial integration and contextual thinking Describe and discuss strategies to change EHR formats to facilitate biopsychosocial integration and contexual thinking during residency training Delineate essential family and social information to be included in EHR systems that promote specific values of family medicine education

Context & Dilemmas

Possibilities and Constraints

Technical Issues EHR (Centricity) determined by institution

Technical Issues EHR (Centricity) determined by institution Standard “Family Medicine Visit” is set Can lobby for change in default form listing

Technical Issues EHR (Centricity) determined by institution Standard “Family Medicine Visit” is set Can lobby for change in default form listing Standard forms cannot be altered Can create forms for default / optional use

EHR (Centricity) determined by institution Standard “Family Medicine Visit” is set Can lobby for change in default form listing Standard forms cannot be altered Can create forms for default / optional use Navigation options: tabs, scrolling, buttons

Technical Issues EHR (Centricity) determined by institution Standard “Family Medicine Visit” is set Can lobby for change in default form listing Standard forms cannot be altered Can create forms for default / optional use Navigation options: tabs, scrolling, buttons Data entry: dropdown, free text, check box

Technical Issues EHR (Centricity) determined by institution Standard “Family Medicine Visit” is set Can lobby for change in default form listing Standard forms cannot be altered Can create forms for default / optional use Navigation options: tabs, scrolling, buttons Data entry: dropdown, free text, check box Data usage: pre-population, reports

Institutional Landscape EHR vendor On-site programmer (but no designer) Clinical EHR oversight committee Providers outside educational sphere / FM Departmental leadership Behavioral science & physician faculty partnership

Family & Social Info Form

Preliminary Pilot Feedback

How was this form used? (Under what clinical circumstances is gathering and organizing contextual information important? ) New patients; Physicals Provider wanted to organize long history of established patient Significant life cycle transition; Immigrant patient Clear psychosocial issue

Preliminary Pilot Feedback In what ways did collecting this information serve clinical goals? Prompts facilitated reflection Deepened knowledge & alliance Adjusted focus of visit Revealed legacies in families Problem list expanded

Preliminary Pilot Feedback What are the challenges to collecting this information in EHR? Discrete categories & boxes Competing EHR / practice demands Time investment

Preliminary Pilot Feedback Reflections about project Enthusiastic response Differences in priorities & approaches Stimulated departmental discussion Some attendings already precepting more about contextual information

Small Group Discussion

Small Groups Groups of 4-6, based on EHR brand Pick one person to facilitate/take notes Questions What contextual information would be important to gather and document for family physicians? Given the realities of the EHR, what strategies are used or could be used at your site to encourage contextual thinking?

Big Group Discussion

Big Group What did your groups discover? What contextual information would be important to gather and document for family physicians? Given the realities of the EHR, what strategies are used or could be used at your site to encourage contextual thinking?

Conclusion

Lessons Learned & Next Steps Lessons Learned Institutional buy-in & resources vital Psychosocial integration is a benefit Time constraints & design are challenges Next Steps Pilot with residents, at multiple sites, & with non-teaching faculty Revise & streamline form In-service users

Take Home EHR challenges contextual & integrated thinking EHR has potential to redefine models of care Family medicine educators can infiltrate EHR structure to protect biopsychosocial model Propose psychosocial EHR working group to maintain contextual thinking test best EHR practices make recommendations