Exam tip: Ask patients to type their concerns into EHR before doctor visit

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In a new study, patients typed their concerns directly into the EHR before meeting with their doctor. Patients and clinicians found the process improved communication.

Doctors sometimes encourage patients to write down their concerns prior to an office visit. But what if patients could type the reasons for their visit right into the electronic health record (EHR), giving their doctor a heads up before getting into the exam room? 

That was what 101 patients did in a small study conducted at Harborview Medical Center, a large primary care safety-net county clinic in Seattle. Patients typed directly into a laptop computer linked to the EHR, with comments such as “my ankle is not getting better” and “[concerned about] lumps on my lung.” Clinicians then looked over those agendas in the electronic progress notes before entering the exam room or at the start of the visit.

The researchers, who published the study in the Annals of Family Medicine, called it “collaborative visit agenda setting” and found it was worth recommending. Patients and the 28 clinicians who participated in the study completed postvisit surveys, and both agreed that the patient agendas improved communication (79% of patients, 74% of clinicians) and wanted to continue using them in the future (73%, 82%).

That was true even though more than 50% of consumers are skeptical about the benefits of healthcare information technologies, including patient portals, mobile apps and EHRs.

“Enabling patients to type visit agendas may enhance care by engaging patients and giving clinicians an efficient way to prioritize patients’ concerns,” the researchers said. Agenda setting may diminish the number of “oh, by the way” concerns at the end of office visits and increase patient satisfaction and engagement.

Patients commented in the follow-up survey: “Gave doctor my information so I wouldn’t be nervous and forget” and “Doctor and I on the same page.” Clinicians said the typed notes gave them time to think about issues ahead of time and engaged the patient to participate more in the visit.

RELATED: Study: Docs spend more time with computers than patients 

The study was the first using OpenNotes to allow patients to write clinic notes in the EHR. Researchers had to exclude patients who were unable to read or write in English or were uncomfortable typing on a computer. Patient notes were brief; 83% typed for less than 10 minutes and 80% typed fewer than 60 words.