Feasibility of a Clinician Training Program To Improve Patient-Provider Communication in the Presence of Health IT Systems in the Exam Room

There are many benefits of electronic health records (EHRs), including improved access to data, decreased healthcare costs, and better care coordination. However, recent studies show unintended consequences, including decreased professional satisfaction and increased clerical work during patient visits. Also, there is a growing interference of EHR use on patient-centeredness, particularly on communication between patients and providers during clinical encounters. Interpersonal communication, especially face-to-face communication, is central to patient-centered care and has a direct impact on care processes and health outcomes.

This study modified the evidence-based Physician Asthma Care Education (PACE) program to train primary care physicians (PCPs) on the effective use of EHRs at the point of care (EHR-PACE). The original PACE program enhanced communication, therapeutic practices, and the ability of clinicians to teach effective asthma self-management of their patients. EHR-PACE added training providers on concepts and skills for strengthening communication using an EHR platform. It also encouraged provider-patient relationships through behavior change principles applicable to patients with asthma. Researchers evaluated whether EHR-PACE improved provider perception of their communication skills and asthma outcomes of their patients.

The specific aims of the project were as follows:

• Development of the EHR version of the evidence-based PACE program to be used as a training tool for clinicians on the effective use of EHRs at the point of care. 
• Assessment of the feasibility of EHR-PACE on patients' perception of their provider's communication and care, and their asthma control and asthma-related quality of life. 

A randomized controlled trial was conducted to compare EHR-PACE to usual care. Participants were PCPs and their adult patients with persistent asthma. Outcomes were assessed using measures such as patient-reported perception of their provider's communication skills, as well as provider-reported confidence in asthma counseling and in using EHRs during clinical encounters. Compared to the control group, physicians who completed the EHR-PACE program reported significant improvements in their confidence with asthma counseling practices and with EHR-specific communication practices at the 3-month followup. Intervention group physicians also reported a significant decrease in the perception that the computer interferes with the patient-provider relationship at the 6-month followup. No significant changes were observed in patient asthma outcomes or their perception of their provider's communication and counseling skills. Researchers found that additional research is needed to fully evaluate EHR-PACE through a larger-scale trial, and more definitively assess its impact on patient health status.