The Israeli Patient-Doctor-Computer communication study: an educational intervention pilot report and its implications for person-centered medicine
AbstractBackground:Electronic Medical Records (EMRs) are presently ubiquitous, transforming the dyadic patient-doctor relationship into a triadic patient-doctor-computer one. Nevertheless, there is a paucity of theoretical and empirical work in the field. The authors’ previous work provides a framework for clinical encounters in the computerized setting and enabled the development of a simulation-based educational intervention (one day workshop with extensive simulated exercises and debriefing) fostering the incorporation of computerized records into consultations. The pilot trial of the intervention and its evaluation is reported.Methods: Scenarios simulating patient-doctor encounters with Simulated Patients (SPs) have been developed based on a blueprint. A high–fidelity customized EMR system was installed at MSR - Israel Center for Medical Simulation. An evaluation package comprised of observation scales for physician-observers, SPs and learners’ self–evaluation was developed. The intervention and post-test were pilot tested on 12 Family Medicine residents.Results:The intervention workshop and post-test were rated highly for quality, relevance, logistics, authenticity and impact. Eight paired self-evaluation surveys were available for interpretation. The average score for self-evaluation performance in the four domain skills (communication, technical use of computer, cross cultural, and error prevention) increased 1.5 points on the average (SD 1.2, range 9-13). A statistically significant increase was computed by the Wilcoxon Signed Ranks Test (Z=-2.4 p<.05). Chronbach’s alpha values were 0.604 for the SPs and 0.529 for the observers’ scales (12 records for each observer).Conclusions: The developed module of an educational intervention for enhancing Primary Care Physicians (PCPs) skills in the computerized setting has been successfully piloted. The simulation, evaluation and debriefing tools developed for the study perform adequately and were found to be acceptable and feasible. A trend towards positive educational impact exists. The study provides a framework of insights and tools for upgrading PCPs performance in the computerized setting. These insights and tools have a real potential to advance the quality, safety and effectiveness of healthcare. This module is ready for final, rigorous testing as well as for serving as a benchmark for future leaner, portable interventions. Potentially, pending the necessary empirical evidence, it may profoundly impact upon quality of care and patient safety and has implications for the development of person-centered medicine.
/healthit_hhs_gov__hitech_programs/1487 accessed Aug 15 2011.
Protti, D., Johansen, I. & Perez-Torres, F. (2009). Comparing the application of Health Information Technology in primary care in Denmark and Andalucia, Spain. International Journal of Medical Informatics 78 (4), 270-283.
Protti, D. (2008). A comparison of how Canada, England and Denmark are managing their electronic health record journeys. In: Human, social, and organizational aspects of health information systems. (Eds. Kushniruk, A.W. & Borycki, E.M.) pp. 203-218. New York: Hershey.
Balicer, R.D., Shadmi, E., Lieberman, N., Greenberg-Dotan, S., Goldfracht, M., Jana, L., Cohen, A.D., Regev-Rosenberg, S. & Jacobson, O. (2011). Reducing Health Disparities: Strategy Planning and Implementation in Israel's Largest Health Care Organization. Health Services Research 46 (4), 1281-1299.
Shachak, A. (2009). The impact of electronic medical records on patient-doctor communication during consultation: a narrative literature review. Journal of Evaluation in Clinical Practice 15, 641-649.
Pearce, C., Dwan, K., Arnold, M., Phillips, C. & Trumble, S. (2009). Doctor, patient and computer - a framework for the new consultation.International Journal of Medical Informatics 78 (1), 32-38.
Shachak, A. & Reis, S. (2010). The computer-assisted patient consultation: promises and challenges In: Healthcare and the Effect of Technology: Developments, Challenges and Advancements. (Ed. Kabene, S.M.). Hershey, PA: Medical Information Science Reference.
Beyth, Y., Hardoff, D., Rom, E. & Ziv, A. (2009). A simulated patient-based program for training gynecologists in communication with adolescent girls presenting with gynecological problems. Journal of Pediatric and Adolescent Gynecology. 22 (2), 79-84.
Shachak, A., Hadas-Dayagi, M., Ziv, A. & Reis, S.
(2009). Primary care physicians' use of an electronic medical record system: a cognitive task analysis. Journal of General Internal Medicine 24 (3), 341-348.
Booth, N., Robinson, P. & Kohannejad, J. (2004). Identification of high-quality consultation practice in primary care: the effects of computer use on doctor-patient rapport. Informatics in Primary Care 12 (2), 75-83.
Ventres, W., Kooienga, S., Vuckovic, N., Marlin, R., Nygren, P. & Stewart, V. (2006). Physicians, Patients, and the Electronic Health Record: An Ethnographic Analysi. Annals of Family Medicine 4 (2), 124-131.
Frankel, R., Altschuler, A., George, S., Kinsman, J., Jimison, H., Robertson, N.R. & Hsu, J. (2005). Effects of exam-room computing on clinician-patient communication: a longitudinal qualitative study. Journal of General Internal Medicine 20 (8), 677-682.
Pearce, C., Walker, H. & O'Shea, C. (2008). A visual study of computers on doctors' desks. Informatics in Primary Care 16 (2), 111-117.
Pearce, C., Arnold, M., Phillips, C., Trumble, S. & Dwan, K. (2011). The patient and the computer in primary care consultation. Journal of the American Medical Informatics Association 18 (2), 138-142.
MSR – Israel Center for Medical Simulation – http://www.msr.org.co.il accessed Aug 20 2011.
Ziv, A., Erez, D., Munz Y, Vardi, A., Barsuk, D., Levine, I., Benita, S., Rubin, O. & Berhenstadt, H. (2006). The Israel Center for Medical Simulation: a paradigm for cultural change in medical education. Academic Medicine 81 (12), 1091-1097.
Farfel, A., Hardoff, D., Afek, A. & Ziv, A. (2010) Effect of a simulated patient-based educational program on the quality of medical encounters at military recruitment centers. Israel Medical Association Journal 12 (8), 455-459.
Epstein, R.M. & Hundert, E.M. (2002). Defining and assessing professional competence. Journal of the American Medical Association 287, 226-235.
Shachak, A. & Fine, S. (2008). The effect of training on biologists' acceptance of bioinformatics tools: a field experiment. Journal of the American Society for Information Science and Technology 59 (5),719-730.
Venkatesh, V. & Davis, F.D. (1996). A model of the antecedents of perceived ease of use: Development and test. Decision Sciences 27 (3), 451-481.