Exploring Family and Social Context Through the Electronic Health Record: Physicians' Experiences

• Published in: Families systems & health Vol. 34; no. 2; pp. 92 - 103
• Main Authors: Kotay, Anu, Huang, James L., Jordan, William B., Korin, Eliana
• Format: Journal Article
• Language: English
• Published: United States Educational Publishing Foundation 01-06-2016; American Psychological Association, Inc; American Psychological Association
• Subjects: Adult; Clinical Practice; Company business management; Disclosure - standards; Disclosure - trends; Documentation - methods; Documentation - standards; Electronic Health Records; Electronic Health Records - instrumentation; Electronic Health Records - standards; Electronic records; Families & family life; Family; Family health; Family medical history; Family Relations; Female; Health; Health aspects; Human; Humans; Influence; Male; Management; Medical care; Medical care quality; Medical Records; Middle Aged; Patient History; Physicians; Physicians - psychology; Primary Health Care - methods; Psychosocial Factors; Quality management; Social Behavior; Social Determinants of Health; social history; social determinants of health; biopsychosocial model; electronic health record; qualitative analysis
• ISSN: 1091-7527; 1939-0602
• DOI: 10.1037/fsh0000190

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.