Protecting healing relationships in the age of electronic health records: report from an international conference

We present findings of an international conference of diverse participants exploring the influence of electronic health records (EHRs) on the patient-practitioner relationship. Attendees united around a belief in the primacy of this relationship and the importance of undistracted attention. They explored administrative, regulatory, and financial requirements that have guided United States (US) EHR design and challenged patient-care documentation, usability, user satisfaction, interconnectivity, and data sharing. The United States experience was contrasted with those of other nations, many of which have prioritized patient-care documentation rather than billing requirements and experienced high user satisfaction. Conference participants examined educational methods to teach diverse learners effective patient-centered EHR use, including alternative models of care delivery and documentation, and explored novel ways to involve patients as healthcare partners like health-data uploading, chart co-creation, shared practitioner notes, applications, and telehealth. Future best practices must preserve human relationships, while building an effective patient-practitioner (or team)-EHR triad

Prevalence and functionality of electronic health records in internal medicine continuity clinics.

PURPOSE: Health information technology (HIT), particularly electronic health records (EHRs), will become universal in ambulatory practices, but the current roles and functions that HIT and EHRs play in the ambulatory clinic settings of internal medicine (IM) residents are unknown. METHOD: The authors conducted a Web-based survey from July 2007 to January 2008 to ascertain HIT prevalence and functionality. Respondents were directors of one or more ambulatory clinics where IM residents completed any required outpatient training, as identified by directors of accredited U.S. IM residencies. RESULTS: The authors identified 356 clinic directors from 264 accredited U.S. programs (70%); 221 directors (62%) completed the survey, representing 185 accredited programs (49%). According to responding directors, residents in 121 of 216 clinics (56%) had access to EHRs, residents in 147 of 219 clinics (67%) used some type of electronic data system (EDS) to manage patient information, and residents in 62 clinics (28% of 219 responding) used an EDS to generate lists of patients needing follow-up care. Compared with smaller IM training programs, programs with \u3e or =50 trainees were more likely to have an EDS (67% versus 53%, P = .037), electronic prescription writer (57% versus 42%, P = .026), or EHR (63% versus 45%, P = .007). CONCLUSIONS: Resident ambulatory clinics seem to have greater adoption of HIT and EHRs than practicing physicians\u27 ambulatory offices. Ample room for improvement exists, however, as electronic systems with suboptimal patient data, limited functionality, and reliance on multiple (paper and electronic) systems all hinder residents\u27 ability to perform important care coordination activities