TY - JOUR
T1 - Exploring family and social context through the electronic health record
T2 - Physicians' experiences
AU - Kotay, Anu
AU - Huang, James L.
AU - Jordan, William B.
AU - Korin, Eliana
N1 - Publisher Copyright:
© 2016 American Psychological Association.
PY - 2016
Y1 - 2016
N2 - Introduction: 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. Method: 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. Discussion: 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.
AB - Introduction: 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. Method: 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. Discussion: 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.
KW - Biopsychosocial model
KW - Electronic health record
KW - Qualitative analysis
KW - Social determinants of health
KW - Social history
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U2 - 10.1037/fsh0000190
DO - 10.1037/fsh0000190
M3 - Article
C2 - 27149050
AN - SCOPUS:85000936585
SN - 1091-7527
VL - 34
SP - 92
EP - 103
JO - Families, Systems and Health
JF - Families, Systems and Health
IS - 2
ER -