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

Failure in clinician-patient communication, lack of clarity regarding clinical treatment
priorities, and more recently, ineffective use of health IT systems in exam rooms are
associated with deficits in achieving chronic disease management goals, and increased
healthcare utilization and costs. Strategies for communicating with patients in exam rooms in
the presence of electronic health records (EHR) have been described in the literature.
Whether such strategies are reaching clinicians and demonstrating positive health outcomes is
unclear. The investigators propose to develop and test the feasibility on patient outcomes of
an interactive training module that teaches clinicians best practices for communicating with
patients in the presence of computer systems in the exam room (specifically EHRs). They
propose to modify and expand the internationally-recognized evidence-based Physician Asthma
Care Education (PACE) program to make it a suitable tool for training primary care clinicians
on the effective use of EHRs at the point of care. The PACE program is based on concepts and
skills for strengthening communication and patient-clinician relationships through behavior
change principles that are highly applicable to patients with asthma and has potential for
specific application to EHR use in clinical practice. The investigators will first develop
the EHR edition of PACE (EHR-PACE) through literature and expert review of best practices for
clinicians interacting with patients in the presence of computer systems in the exam room.
They will then establish the feasibility and potential impact of EHR-PACE via a randomized
design on 125 patients of 20 physicians who receive the intervention on the following
outcomes via survey 3 and 6 months post-intervention: patient satisfaction with the
physician's performance, asthma control, and asthma-related quality of life. Outcomes will be
assessed on patients, but physicians will receive the intervention.Patients will not know
which arm their doctor was randomized to.The pilot trial will compare two groups of primary
care physicians who see patients with asthma in clinics equipped with certified EHRs. It is
hypothesized that patients of physicians who receive EHR-PACE training will achieve better
outcomes compared to physicians who do not receive EHR-PACE.

EHR-PACE developed in this study is expected to have a high degree of relevance for improving
the patient-provider communication skills of clinicians who see a wide range of patients in a
variety of practice settings that have now integrated EHRs. Given that PACE can achieve
dramatic outcomes within only two, 2-hour sessions, EHR-PACE has the potential to become an
invaluable training tool to busy clinicians if proven feasible and effective. Ultimately,
this work has potential for a high degree of impact.

Inclusion Criteria:

Physicians:

1. Licensed physician in practice and board certified in primary care or family medicine

2. Treating adults with asthma

3. Full-time in a practice at an Integrated Health Associates clinic that has implemented
a certified EHR system for at least one year

4. Consent to participate

5. Will generate a roster of adult asthma patients for inclusion in the study

Patients:

1. Treated by the participating physician during the study intake period

2. 18 years of age or older

3. Have a diagnosis of asthma made by a physician using the National Asthma Education and
Prevention Program Guidelines

4. Have at least one urgent medical care visit for asthma in the previous year

5. Have access to a telephone

6. Consent to participate

Exclusion Criteria:

Patients:

1. Have other chronic disorders that have pulmonary complications