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Patient-entered histories can streamline office visits. But can you trust them to tell their stories without you?
From gas station fill-ups to airport check-ins, we are rapidly becoming a self-service society. Is there a way this trend might benefit docs in ambulatory practice?
Yes. It’s called patient-entered histories.
Here’s the basic idea behind this brand of self-service medicine: A patient fills out an interactive computer questionnaire prior to a visit. Her responses are automatically transferred to her electronic chart. That way, when the physician sees the patient, he is reviewing the patient’s questionnaire and can focus on the objective, assessment, and plan part of the visit.
Proponents of patient-entered histories claim the following benefits:
Since computer-based patient-entered histories work by using structured Q & A or a checklist type of approach, they offer a more consistent, standardized method of information gathering. Computer-based questionnaires also tend to excel at collecting sensitive information that patients may not feel comfortable verbalizing in a face-to-face encounter.
This all sounds good on paper. But does it work in the real world?
To answer this, I found a small, primary-care practice that had integrated patient-entered histories into its daily routine. Here are my questions and their responses:
OK, that sounds pretty good. So what are the important caveats?
Like most innovations, there are costs and work flow changes required to make it fly. You will need a Web site, a subscription to a company that creates the patient questionnaires, and an EMR. I suppose a paper-based practice with a Web site or patient kiosks could use this tool too, but doing so will add the task of getting the completed questionnaires into the charts - an unwieldy proposition that nearly negates the work flow benefits of patient-entered histories. You’ll also need to take some time training your reception and clinical staff to direct patients to the Web site prior to appointments.
Of course, not everyone is going to like talking to the computer prior to a visit, so you will have to put processes in place to manage exceptions (such as using the MA to walk the patient through the interview, as described above).
Finally, note that while the patient-entered history is a time-saver and offers a more standardized approach to patient interviews, it is no replacement for clinicians. Computers are terrible at picking up nonverbal cues, and patients tend to over-report on questionnaires, leading to a higher false positive rate.
However, in an increasingly online era, patient-entered histories do offer the promise of nicely combining good medicine for patients and improved productivity for the practice.
Bruce Kleaveland is president of Kleaveland Consulting, a management consulting firm focused on healthcare IT. Prior to forming Kleaveland Consulting, he was chief operating officer at a leading EMR company. He can be reached via firstname.lastname@example.org.
This article originally appeared in the July/August 2008 issue of Physicians Practice.