Online Program

To EHR is human: Impact of health information technology on patient-doctor communication in clinics serving low-income populations in a large and diverse Medicaid health plan

Tuesday, November 3, 2015 : 4:30 p.m. - 4:50 p.m.

Rae Starr, L.A. Care Health Plan, Santa Monica, CA
“Skeptics of health information technology (HIT) as a clinical tool, express that technology in the exam room distracts patient-doctor communication and lowers the quality of patient-centered care.  This study presents evidence supporting a narrow part of that concern, but more broadly affirms the opposite view: that HIT can noticeably enhance the quality of communication as reported by patients.

(1) Background: The study examines the impact of EHRs use by clinicians serving low-income patients in a large and diverse Medicaid health plan.

(2) Objective/purpose: Determine whether EHRs impair or enhance patient-doctor communication and patient-centered care in clinical settings.

(3) Methods: Data on clinicians’ EHR adoption (2010 to 2013) from a regional HITEC program in Los Angeles County, California, were matched against patients’ ratings of provider communication and related quality measures from CAHPS patient experience surveys for Medicaid patients.  Two patient surveys from different time periods (2011: n=16,288 and 2014: n=22,671) were employed to capture the effect of maturation in clinicians’ use of EHRs.  The EHR data and the patients’ ratings were both gathered independently, as double-blind measurements separate from this study.

(4) Results: Statistically significant effects were observed for HIT on several measures of patient-doctor communication – most visibly after clinics attained meaningful use.  Hence maturation is an important factor to measure.  The effects differed by demographic: Adult patients moved from negative to largely-positive ratings as stages of EHR adoption progressed.  In contrast, parents of pediatric patients gave HIT adopters positive ratings much earlier in the process.

(5) Discussion/conclusions: Results on maturation suggest that clinicians’ training and familiarity with HIT tools is an important factor in patients’ response to HIT.  The strong differences between adult patients and parents’ ratings, suggest that clinician trainings on patient-centered care should differentiate between adults and children/parents, respectively, in how HIT is employed in office visits.

Learning Areas:

Biostatistics, economics
Communication and informatics
Conduct evaluation related to programs, research, and other areas of practice
Program planning

Learning Objectives:
Compare two opposing predictions or hypotheses from the literature about the expected impacts of HIT on patient-provider communication in the clinic. Describe measured differences in the speed of adoption of EHRs in clinics which serve low-income (Medicaid) members versus clinics in the general market. Compare differences of adult patients versus parents of pediatric patients in rating provider communication in clinics with EHRs. Describe the impact of maturation on ratings of provider communication and related quality-of-service measures. Explain one prominent reason why provider communication is an earlier indicator of EHR adoption, than other common measures of service quality from the patient perspective. Identify two common surveys routinely used by health plans that can be used to evaluate the human outcomes of HIT for patients and providers.

Keyword(s): Information Technology, Patient-Centered Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Have served 12 years as a statistician at the largest public health plan in the United States, which serves low-income Medicaid and dual-eligible Medicare patients in an ethnically diverse county in the southwest United States. Managed CAHPS patient experience survey from 2006 to 2015, including analysis of patient-provider communication measures. Co-designed and conducted evaluations of programs to implement e-prescribing using handheld computers; and researched attributes of early-adopters of health information technology.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.