title: Exploring family and social context through the electronic health record: Physicians' experiences.
abstract: BACKGROUND
  There is ample evidence that social and familial context significantly impacts health. However, family and social history templates typically used in clinical practice exclude prompts to explore important contextual information, such as family dynamics, health beliefs, housing, and neighborhood environment.
  
  
  METHODS
  At the Residency Program in Social Medicine at Montefiore Medical Center/Albert Einstein College of Medicine in Bronx, NY, we developed and piloted an expanded family and social information (FSI) template in our electronic health record (EHR) system. After 10 physicians used the FSI template during routine clinical practice, we conducted and qualitatively analyzed transcripts of semistructured interviews to assess their experiences.
  
  
  RESULTS
  The major themes of physician's experiences using the FSI template included: expanded thinking (promoted thinking and discussion about contextual information), relevancy to care (highlighted important life events, helpful resource for future care or for team-based care), fragmentation (patient narrative difficult to categorize into discrete sections), and abstract phrasing (prompts too abstract and/or too complex to explore well). Some minor themes (themes that were repeated often, but not consistent in all interviews) were also noted: practice demands, educational purpose, and wish list.
  
  
  CONCLUSIONS
  Within our small sample, we found that an expanded family and social information template broadened physicians' clinical thinking during routine visits. We also found that the structure of the EHR and practice demands create significant barriers to exploring a patient's narrative effectively. Themes identified in this research will inform national efforts to prioritize a contextual and biopsychosocial perspective in EHR systems. (PsycINFO Database Record
authors.affiliation: Department of Family and Social Medicine, Montefiore Medical Center/Albert Einstein College of Medicine.
authors.forename: Anu
authors.initials: A
authors.lastname: Kotay
authors.affiliation: Department of Family and Social Medicine, Montefiore Medical Center/Albert Einstein College of Medicine.
authors.forename: James L
authors.initials: JL
authors.lastname: Huang
authors.affiliation: Department of Family and Social Medicine, Montefiore Medical Center/Albert Einstein College of Medicine.
authors.forename: William B
authors.initials: WB
authors.lastname: Jordan
authors.affiliation: Department of Family and Social Medicine, Montefiore Medical Center/Albert Einstein College of Medicine.
authors.forename: Eliana
authors.initials: E
authors.lastname: Korin
mesh_terms: D000328:Adult; D030881:Disclosure / Q000592:standards* / Q000639:trends; D004282:Documentation / Q000379:methods / Q000592:standards; D057286:Electronic Health Records / Q000295:instrumentation / Q000592:standards*; D005195:Family Relations; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000523:psychology*; D011320:Primary Health Care / Q000379:methods; D012919:Social Behavior