Physicians' perceptions of the impact of the EHR on the collection and retrieval of psychosocial information in outpatient diabetes care

Charles Senteio; Tiffany Veinot; Julia Adler-Milstein; Caroline Richardson

doi:10.1016/j.ijmedinf.2018.02.003

Physicians' perceptions of the impact of the EHR on the collection and retrieval of psychosocial information in outpatient diabetes care

Int J Med Inform. 2018 May:113:9-16. doi: 10.1016/j.ijmedinf.2018.02.003. Epub 2018 Feb 21.

Authors

Charles Senteio¹, Tiffany Veinot², Julia Adler-Milstein³, Caroline Richardson⁴

Affiliations

¹ Rutgers School of Communication and Information, Department of Library and Information Science, 4 Huntington St., New Brunswick, NJ, 08901-1071, USA. Electronic address: Charles.senteio@rutgers.edu.
² University of Michigan, School of Information and School of Public Health, Ann Arbor, MI, USA. Electronic address: tveinot@umich.edu.
³ University of Michigan, School of Information and School of Public Health, Ann Arbor, MI, USA. Electronic address: juliaam@umich.edu.
⁴ University of Michigan Medical School, Department of Family Medicine, Ann Arbor, MI, USA. Electronic address: caroli@med.umich.edu.

PMID: 29602438
DOI: 10.1016/j.ijmedinf.2018.02.003

Abstract

Background: Psychosocial information informs clinical decisions by providing crucial context for patients' barriers to recommended self-care; this is especially important in outpatient diabetes care because outcomes are largely dependent upon self-care behavior. Little is known about provider perceptions of use of psychosocial information. Further, while EHRs have dramatically changed how providers interact with patient health information, the EHRs' role in collection and retrieval of psychosocial information is not understood.

Methods: We designed a qualitative study. We used semi-structured interviews to investigate physicians' (N = 17) perspectives on the impact of EHR for psychosocial information use for outpatient Type II diabetes care decisions. We selected the constant comparative method to analyze the data.

Findings: Psychosocial information is perceived as dissimilar from other clinical information such as HbA1c and prescribed medications. Its narrative form conveys the patient's story, which elucidates barriers to following self-care recommendations. The narrative is abstract, and requires interpretation of patterns. Psychosocial information is also circumstantial; hence, the patients' context determines influence on self-care. Furthermore, EHRs can impair the collection of psychosocial information because the designs of EHR tools make it difficult to document, search for, and retrieve it. Templates do not enable users from collecting the patient's 'story', and using free text fields is time consuming. Providers therefore had low use of, and confidence in, the accuracy of psychosocial information in the EHR.

Principal conclusions: Workflows and EHR tools should be re-designed to better support psychosocial information collection and retrieval. Tools should enable recording and summarization of the patient's story, and the rationale for treatment decisions.

Keywords: Diabetes; Electronic health records; Health informatics; Outpatient care; Social determinants.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Ambulatory Care*
Attitude of Health Personnel*
Diabetes Mellitus, Type 2 / psychology*
Diabetes Mellitus, Type 2 / therapy*
Electronic Health Records*
Female
Humans
Information Dissemination
Male
Perception
Physicians / psychology*
Psychometrics*
Qualitative Research
Stress, Psychological*