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

2. 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

3. 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

4. Context & Dilemmas

5. Possibilities and Constraints

6. Technical Issues EHR (Centricity) determined by institution

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

8. 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

9. 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

10. 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

11. 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

12. 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

13. Family & Social Info Form

20. Preliminary Pilot Feedback

21. 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

22. 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

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

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

25. Small Group Discussion

26. 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?

27. Big Group Discussion

28. 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?

29. Conclusion

30. 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

31. 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