Using electronic health records to promote patient engagement in treatment: Strategies, barriers, and implications for practice

Background: While there is much to learn about the impact of electronic health records on health care delivery (EHRs), these systems are integrated into clinical encounters remains a largely understudied area. Collaborative documentation, where providers complete progress notes together with patients, has been promoted as a patient-centered practice that encourages patient engagement, yet little empirical research has been conducted in order to support this claim. Further, this process requires providers to refine traditional workflows in order to incorporate technology into clinical encounters, but evidence-based best practices surrounding implementation have yet to emerge. Thus, research identifying effective collaborative documentation strategies and exploring its impact on patient engagement is sorely needed.

Objective: To investigate how behavioral health professionals utilize EHRs within clinical encounters, and identify how systems may enhance or inhibit patient-centered practices.

Methods: This qualitative study consisted of semi-structured interviews with 46 behavioral health professionals working in a New York based community health center. Thematic analysis was utilized to inductively identify common experiences of staff members using collaborative documentation. Where disparities became apparent, cross case analysis was utilized to understand root causes of these differences.

Results: Providers largely perceived collaborative documentation as a helpful mechanism to elicit patient participation in treatment. Strategies employed by providers to enhance patient acceptance of collaborative documentation included turning the monitor toward the patient, soliciting patient feedback as they typed, and orienting patients to the system at the outset of treatment. Barriers to implementation included time constraints, provider buy-in, and insufficient computer literacy.

Discussion: These findings illuminated several useful strategies that may be employed to utilize collaborative documentation as a tool for engagement. Results suggests, however, that implementing collaborative documentation requires a number of unique skills that should be incorporated into training programs for professionals engaging in this process. Implications for practice will be discussed.