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- 2018 ABIM Foundation Forum: [Re]Building Trust
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- Graphic Medicine – Alkureishi
- Trust in Transparency and Public Reporting – Queram
- Getting Rid of Stupid Stuff – Ashton
- UnityPoint Health Prairie Parkway LGBTQ Clinic – Christiason
- Colleges Advisory Program – Shochet
- Voice of Duke Health Listening Booth and Podcast – Zuiker
- The Leader Index – Swensen
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Graphic Medicine to Empower Patients to Trust Physicians Using Electronic Health Records
Author: Lolita Alkureishi, MD
Organization: University of Chicago Medicine
Practice Category: Communications/Knowing Your Patient
Relational Type: Trust between patient and physician
The University of Chicago developed a comic strip to foster better patient engagement involving electronic health record (EHR) systems based on published studies and systematic reviews on the impact of technology use on the patient-provider relationship and communication. By analyzing the literature, particularly those on patient perspectives, they identified three core advocacy behaviors that patients and family members should be aware of in order to promote a more collaborative and patient-centered EHR interaction with their providers.
The comic is entitled “Computers in the Clinic: YOUR ROLE!” and is listed in an easy-to-read ABC format. The first advocacy behavior is “A – Ask to see the screen,” and the comic depicts a patient feeling left out of the clinic visit because their provider is not sharing the screen and being transparent about what they are doing on the computer. On the second frame, the comic depicts a more ideal interaction where the patient lets the provider know they are feeling left out of the conversation and asks to see the screen, to which the physician responds by facilitating shared viewing to show the patient the EHR.
The second advocacy behavior is “B – Become Involved. Review your records with your doctor and ask questions,” and the comic depicts a scene where a patient notices that the EHR lists a medication they are not taking and tells the provider about the discrepancy. The provider thanks the patient for catching the error and they are able to correct it together.
The last advocacy behavior is “C – Call for Attention. If you have something sensitive to discuss, speak up and ask for your doctor’s full attention.” The comic shows a scene where the patient wants to discuss something difficult with their provider, who is more focused on the computer screen than on the patient. When the patient speaks up and asks the provider to pay attention to them, the physician turns away from the screen and gives the patient their complete focus.
The comic aims to orient patients to their role with respect to the EHR and actively invites them to try concrete behaviors that can help promote patient-doctor-EHR engagement. Research has found that when technology is used as an educational tool to promote discussion and dialogue, patients understand their medical conditions better, there are opportunities for shared-decision making, and patient satisfaction improves.
- Trust and engagement
- Fluency/facility with EHR
- Familiarity with patient education tools
- Effective workflow design
Proof of Concept:
Survey results show that patient-centered EHR advocacy is having an impact. Seventy-two percent (224/313) of pediatric parents and 70 percent (114/162) of adult patients agreed the comic effectively encouraged them to be more involved in the EHR during their visits. Sixty-seven percent (105/157) of adult patients and 57 percent (164/286) of pediatric parents said their provider was less distracted by the computer and more focused on them. Furthermore, 61 percent (98/160) of adult patients and 55 percent (158/286) of pediatric parents stated they understood more about their/their child’s health or treatment plan because of how their provider used the computer to provide education. Fifty-five percent (79/144) of adult patients and 47 percent (131/281) of pediatric parents were more satisfied with their relationship with their physician because of how they used the computer with them.
“At its core, our practice relies on trust. A patient needs to trust that their relationship with their provider is one that allows them to ask questions without fear of upsetting their provider or appearing as a challenging or “difficult” patient. Patients need to feel that their providers will be receptive to their questions. Patients need to trust that their engagement will be viewed as a positive by their health care team, and trust that the benefit of this involvement is increased understanding of their health and improved satisfaction with the decisions they make with their provider.”
Black and Hispanic parents were more likely than White parents to ask to see the screen and become involved with the EHR due to the comic (p=.023, p=.006). Adult African American and Hispanic patients were more likely to ask to see the screen as a result of the comic compared to White patients (p=0.010). Lower education levels were associated with higher rates of self-advocacy behaviors in both groups including: asking to see the screen (rs=-0.180, p≤.003; r= -0.2732, p=0.0008 respectively), asking to be involved (rs=-0.193, p≤.001; r=-0.2442 p =0.0028 respectively), and calling for providers’ attention (rs=-0.125, p≤.040; r =-0.1624 p =0.0494 respectively). Adult female patients were more likely than male patients to ask to be involved with their doctor’s computer use (z=2.176, p=0.0295).
On telephone follow-up, all pediatric parents (50/50) and 90 percent (45/50) of adult patients remembered the comic. When asked about their behaviors at subsequent doctors’ visits, pediatric parents reported significant increases in asking to see the screen (median 3 vs. 4, z = 5.178, p<.001); calling for attention (median 3 vs. 4, z=4.661, p<.001); and feeling empowered to get more involved with computer use (median 3 vs. 4, z=4.123, p<.001). Adult patients reported an increase in asking to see the screen (median 3 vs. 4, z=2.746, p<0.01) at their subsequent doctors’ visits.
The patient engagement comic was designed to be easily read and understood by people with a range of literacy and educational levels. It is compact enough that it can be distributed on a small card and can be featured in other high-visibility settings such as in waiting rooms, clinic TV screens, etc. The team that developed the comic supports its reproduction and dissemination free of charge. Further, the comic requires no explanation and can be quickly read prior to a patient’s visit. The comic can be translated into other languages, making its use appropriate for a variety of different settings and patient populations.
See more Trust Practice Winners:
- “Getting Rid of Stupid Stuff” by Melinda Ashton, MD
- “UnityPoint Health Prairie Parkway LGBTQ Clinic“ by Kyle Christiason, MD
- “Relational Leadership Institute” by Brian Park, MD, MPH
- “Trust in Transparency and Public Reporting” by Christopher Queram
- “The Colleges Advisory Program” by Robert Shochet, MD
- “The Leader Index” by Stephen Swensen, MD
- “Voice of Duke Health Listening Booth and Podcast” by Anton Zuiker