Training to improve patient-centered electronic health record (EHR) use

Background: Electronic health records (EHRs) are used across healthcare systems to reduce clinical care errors, improve care team communication, and enhance care coordination and patient safety. However, one criticism is that EHRs increase the provider's engagement with the computer and decrease engagement with the patient leading to less patient-centered care. Patient-centered care is personalized care tailored to individual patient needs and preferences. Interventions have been suggested to help manage EHR use during visits while balancing computer interaction and patient-centered care. Methods: Using the Resident-as-Teacher: a layered learning intervention, patient care training, patientcentric EHR use and team development of residents is balanced with creating a shared understanding of these processes. New interns serve as scribes for the senior residents, observing how patient care is conducted while taking notes necessary for charting and billing requirements. The intern and senior resident together navigate the EHR to ensure proper documentation. In addition, attending physicians precept every patient, providing the aspect of layered learning. The roles are then reversed and the senior resident becomes the intern's scribe. The intern is able to focus on patient care without any distractions that would have been present if the intern was fully in charge of the visit. The resident addresses any missed items with the intern before conclusion of each office visit. EHR training in this manner resulted in 15% more patient encounters while building rapport between the residents. Our assessment included an examination of patient visit counts and an open-ended survey administered to all interns and residents. Adapting training to telehealth during COVID-19 highlights adaptations to in-person training that could be implemented in the virtual environment while maintaining connection between the preceptor and resident. For example, use of a "virtual precepting room", providing the most up to date best practice information and training residents how to provide the best possible care with the limited information received when only seeing the patient virtually. We conducted qualitative interviews with residents approximately one month into the training to assess residents' perceptions of its impact and support they received. Results: Analysis of the Resident-as-Teacher suggests that it provided more patient interactions for interns and residents, as well as facilitated rapport building on the team. For adapting training to telehealth, interviews with residents noted a few challenges but support from attendings was appreciated. Conclusions: EHRs have been viewed more as a system required in health care and less of a tool to aid in organization and communication. With appropriate training, EHRs can be an asset to clinical care while working in conjunction with patient-centered care. Providers working together during a resident training period can promote a beneficial learning curve for both patient care and reducing providers' amount of work after clinic.