Patient and family engagement in communicating with electronic medical records in hospitals: A systematic review

Abstract

Background

Use of electronic medical records (EMRs) in hospitals affects how individuals communicate with each other.

Objective

To examine how EMRs mediate communication between inpatients, their families, and health professionals to support patient and family engagement in care.

Methods

The following electronic bibliographic databases were searched for relevant studies: Association for Computing Machinery Digital Library, CINAHL, Medline, the Cochrane Central Register of Controlled Trials, PsycInfo, and EMBASE.

Results

The search identified 850 papers, and of these, 32 met the inclusion criteria. Interactions with the EMR tended to be unidirectional in nature, where health professionals consulted with patients and families to update patient information. Engagement rarely extended to facilitating patient and family participation beyond consultation. There were few examples of patient and family partnership and shared leadership, mainly with secure messaging and use of the patient portal. Strategies that worked in facilitating active engagement involved patients and families employing creative means of gathering information and directing this information to health professionals. Use of such strategies were rare and involved the attributes of particular individuals, rather than considering the inherent culture of clinical settings.

Conclusion

Further research is urgently needed to examine possibilities of patient and family involvement in treatment modalities, and partnership and shared governance in using the EMR.

Introduction

Electronic medical records (EMRs) are a digital means by which information is stored, managed and utilized in hospitals. These records comprise management of patients’ care, the clinical data repository, order entry and clinical decision support [1]. EMRs can contain various components, including patient portals, secure messaging, and computerized physician order entry. This systematic review considers patient and family engagement during hospitalization comprising the EMR and these various components.

Clear communication is important to ensure safe and effective patient care in hospital settings [2], [3], [4], [5], [6]. The adoption of EMRs in hospitals affects the ways in which health professionals communicate with patients and families. For communication to facilitate participation in health care, patient and family engagement is paramount. Engagement enables patients and families to obtain evidence-based knowledge, to understand available treatment options, and to participate in decision making that reflects their preferences [7], [8], [9]. Past work has demonstrated that patient and family engagement can lead to reductions in serious adverse events and medication errors, and improved quality of care [10], [11].

Despite the importance of patient and family engagement during patients’ hospitalizations, there has been insufficient attention in this area from previous systematic reviews. Systematic reviews on EMRs have focused on the benefits and efficiencies associated with their use, development and implementation of EMRs, usability evaluations of health information systems, and challenges in transitioning from paper-based systems to the EMR [12], [13], [14]. Emphasis has been placed on physician-patient relationships with little attention given to other health professionals [15], [16], [17]. Past work has tended to comprise examination of all forms of technology, thereby potentially attenuating the influence of the EMR [15], [16], [17]. Previous systematic reviews have examined inpatient engagement with diverse health information technologies [18], and communication with patient portals during hospitalization [19], [20]. Some included studies in these systematic reviews have involved an examination of health professional perceptions of patient experiences. Unfortunately, there has been inadequate focus on verbal and written communication with the EMR from patients’ and families’ perspectives during hospitalization, and the ways in which communication affects patient and family engagement.

The aim of this systematic review was to examine how EMRs mediate communication between inpatients, their families, and health professionals to support patient and family engagement in care. A mnemonic for systematic reviews, PICo, was utilized to develop the research question. The components of the research question according to PICo are population (patients, families, and health professionals), phenomenon of interest (communication to enable patient and family engagement) and context (EMR in hospitals) [21]. The research question that guided the systematic review was: how do EMRs mediate communication between inpatients, their families and health professionals to support patient and family engagement in care?