title: Strategizing EHR use to achieve patient-centered care in exam rooms: a qualitative study on primary care providers.
abstract: OBJECTIVE
  Electronic health records (EHRs) have great potential to improve quality of care. However, their use may diminish "patient-centeredness" in exam rooms by distracting the healthcare provider from focusing on direct patient interaction. The authors conducted a qualitative interview study to understand the magnitude of this issue, and the strategies that primary care providers devised to mitigate the unintended adverse effect associated with EHR use.
  
  
  METHODS
  Semi-structured interviews were conducted with 21 healthcare providers at 4 Veterans Affairs (VAs) outpatient primary care clinics in San Diego County. Data analysis was performed using the grounded theory approach.
  
  
  RESULTS
  The results show that providers face demands from both patients and the EHR system. To cope with these demands, and to provide patient-centered care, providers attempt to perform EHR work outside of patient encounters and create templates to streamline documentation work. Providers also attempt to use the EHR to engage patients, establish patient buy-in for EHR use, and multitask between communicating with patients and using the EHR.
  
  
  CONCLUSIONS
  This study has uncovered the challenges that primary care providers face in integrating the EHR into their work practice, and the strategies they use to overcome these challenges in order to maintain patient-centered care. These findings illuminate the importance of developing "best" practices to improve patient-centered care in today's highly "wired" health environment. These findings also show that more user-centered EHR design is needed to improve system usability.
authors.affiliation: Department of Biomedical Informatics, University of California, San Diego, San Diego, CA, USA Health Services Research & Development, VA San Diego Healthcare System, San Diego, CA, USA.
authors.forename: Jing
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Health Services Research & Development, VA San Diego Healthcare System, San Diego, CA, USA Department of Informatics, University of California, Irvine, Irvine, CA, USA yunanc@ics.uci.edu.
authors.forename: Yunan
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Health Services Research & Development, VA San Diego Healthcare System, San Diego, CA, USA.
authors.forename: Shazia
authors.initials: S
authors.lastname: Ashfaq
authors.affiliation: Department of Internal Medicine, VA San Diego Health Care System, San Diego, CA, USA Department of Medicine, University of California, San Diego, San Diego, CA, USA.
authors.forename: Kristin
authors.initials: K
authors.lastname: Bell
authors.affiliation: Health Services Research & Development, VA San Diego Healthcare System, San Diego, CA, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Calvitti
authors.affiliation: Department of Medicine, University of California, San Diego, San Diego, CA, USA.
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Farber
authors.affiliation: Department of Internal Medicine, VA San Diego Health Care System, San Diego, CA, USA Department of Medicine, University of California, San Diego, San Diego, CA, USA.
authors.forename: Mark T
authors.initials: MT
authors.lastname: Gabuzda
authors.affiliation: Health Services Research & Development, VA San Diego Healthcare System, San Diego, CA, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Gray
authors.affiliation: Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA, USA.
authors.forename: Lin
authors.initials: L
authors.lastname: Liu
authors.affiliation: Health Services Research & Development, VA San Diego Healthcare System, San Diego, CA, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Rick
authors.affiliation: Department of Communication, Texas A&M University, College Station, TX, USA.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Street
authors.affiliation: School of Public Health Department of Health Management and Policy, School of Information, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Kai
authors.initials: K
authors.lastname: Zheng
authors.affiliation: Health Services Research & Development, VA San Diego Healthcare System, San Diego, CA, USA.
authors.forename: Danielle
authors.initials: D
authors.lastname: Zuest
authors.affiliation: Health Services Research & Development, VA San Diego Healthcare System, San Diego, CA, USA Department of Medicine, University of California, San Diego, San Diego, CA, USA West Health Institute, La Jolla, CA, USA.
authors.forename: Zia
authors.initials: Z
authors.lastname: Agha
mesh_terms: D000554:Ambulatory Care Facilities; D001291:Attitude of Health Personnel; D002140:California; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D009723:Nurse-Patient Relations; D018802:Patient-Centered Care; D010817:Physician-Patient Relations; D011320:Primary Health Care; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans
keywords: communication; doctor patient relations; electronic health records; patient-centered care