Skip to main content

The Potential of Pre-visit Patient Information

To the Editor:

The escalating provider’s obligations and relatively short and fixed time of clinical encounters in primary care and in specialty ambulatory care constitute a major problem with worldwide prevalence and myriad adverse effects (1). Both system changes and personal providers’ changes have been proposed, but creative solutions are still in demand. One attractive option is enhancing the yield of the time-constrained encounter by getting more out of the immediate pre-visit period.

Holt et al. have provided a good example of this approach. They invited patients to supply significant contextual and personal data before encountering their provider. A randomized controlled trial of this vs. standard care demonstrates significant improvements in varied measures of patient-provider communication (2), proving that providers who had prior access to more patient-related information could achieve better communication, and by inference, better patient-physician relationship, trust, adherence, and health outcomes (3, 4).

The same principle could be adopted and applied for gaining essential patient data from the patient’s electronic health record (EHR). For the majority of patients seen, a wealth of information is already embedded in their EHR, and is accessible to the provider before the patient’s entrance. Instead of severing the continuity and “flow” of the time-restricted clinical encounter by browsing through different indispensable components of the EHR (e.g., previous visits, laboratory results, imaging, medications) and, thus, necessarily being immersed in the screen at the expense of eye contact with the patient, attentiveness to non-verbal and subtle cues, and reacting to the patient, much can be accomplished beforehand. Instead of merely opening the EHR before inviting the next patient (5), the clinician should study its essentials. This would include the essence of the past medical history, medications, recent blood tests, and imaging results which can be transcribed into a brief note if necessary, as an “aide-memoire.” All this can be done in much less than 5 minutes (personal experience) so that when meeting the patient, a common ground is already established and an uninterrupted continuum of eye and verbal contact can ensue, compliant with patients’ wishes. By the same token, the information gleaned during the encounter is committed to memory and incorporated into the EHR after the verbal and physical encounter, together with looking up databases when needed and filling of tests, referrals, and prescriptions. Thus, a preview of the patient’s data prior to the ambulatory encounter can be routinely adopted, and likely to positively affect patient-physician communication and relationship.

References

  1. Tsiga E, Panagopoulou E, Sevdalis N, et al. The influence of time pressure on adherence to guidelines in primary care: an experimental study. BMJ Open 2013; 3:e002700.

    Article  Google Scholar 

  2. Holt JM, Cusatis H, Winn A, et al. Impact of pre-visit contextual data collection on patient-physician communication and patient activation: a randomized trial. J Gen Intern Med 2021; 36:3321-9.

    Article  Google Scholar 

  3. Street RL Jr, Makoul G, Arora NK, Epstein RM. How does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Educ Couns 2009; 74: 295-301.

    Article  Google Scholar 

  4. Stewart MA. Effective physician-patient communication and health outcomes: a review. CMAJ 1995; 152:1423-33.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Lanier C, Dao MD, Baer D, et al. How do patients want us to use the computer during medical encounters? – a discrete choice experiment study. J Gen Intern Med 2021; 36:1875-82

    Article  Google Scholar 

Download references

Funding

Not applicable

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ami Schattner MD.

Ethics declarations

Conflict of interest

The author declares that he does not have a conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Schattner, A. The Potential of Pre-visit Patient Information. J GEN INTERN MED 37, 2091 (2022). https://doi.org/10.1007/s11606-022-07478-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-022-07478-5