5.2. Presentation of themes
5.2.3. Electronic narrative / eNarrative
106 5.2.2.4. Deliver better patient care and scheduling
EHRs increase patient satisfaction by offering self-assisting features that enable patients to schedule/cancel appointments online or access lab reports from home (Belmont & Singh, 2018).
EHRs further improve in-patient access to care by using a secure internet connection that allow healthcare professionals to conduct web consultations and/or generate reports from home or office. In addition, EHRs also contribute to an improvement in preventive care by tracking patient health maintenance reminders, compliances and follow-up activities (Ajami &
ArabChadegani, 2013).
According to Wu and LaRue (2017), EHR benefits are experienced and evaluated depending on the different EHRs functionalities. Decision-making in oncology care depends on the available information in the patient EHRs. If there is missing information, the service outcome could be inadequate (Devkota & Devkota, 2014).
Evans (2016) said that EHRs positively impact decision-making due to its easy accessibility and information summary displayed on the screen that render healthcare professionals less prone to errors.
Despite the advantages that EHRs present, there are challenges that healthcare professionals face when using EHRs such as technical issues, loss of data, data capturing, and omitting information when typing in EHRs (Gesulga et al., 2017). As one participant explained: “Data that has been captured gets lost when connectivity is lost before content can be saved, or it could even be deleted” (OC3-PH1-r1.3). Data loss can impact healthcare service outcomes since healthcare professionals may not have access to relevant information at that specific moment (Wu & LaRue, 2017). As result, one participant shared that “we must be conscious of regularly backing up data off site”
(OC4-PH1-r1.3). As Yanamadala et al. (2016) said, the reduction of data loss can only be done through electronic backups.
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According to Langhan et al. (2014) the methods and reasons for adopting new technologies are often poorly understood by healthcare professionals. The driving force behind the decision to implement new technologies must always be communicated when the technology is introduced.
Ideally, healthcare professionals should be a part of the decision-making team to implement a new system. Healthcare professionals are the primary end users of technologies such as EHRs – they understand, perhaps better than anyone, what the challenges of their daily tasks imply (Liu, Weng & Yu, 2012). Healthcare professionals are often frustrated and stressed about the adoption and implementation of any new IT system. This is mostly as result of unknown realities they fear they may face when using the newly introduced system.
All participants mentioned that currently there is no presence of electronic narratives (audio and video) in oncology care. Electronic narrative is a digital version of a patient’s narrative records which combines video, sound, animation, text, music and narrative voice (Cunsolo, Harper & Edge, 2012). The authors added that electronic narratives are used to record the diagnosis, treatment and recovery processes to promote patient well- being. The findings show that there is limited knowledge about electronic narrative in oncology care. Nevertheless, some of the participants mentioned that they have been familiarising themselves with narratives in healthcare (OC1-PH1-r2.4; OC2-PH1-r2.4;
OC10-PH3-r2.4) while the majority of participants (thirteen out of eighteen) said that they were eager to see electronic narratives implemented in their oncology care due to its focus on patient-centred stories.
The research done by Pérez et al. (2013) proved that electronic narratives have been emerging effectively in healthcare as a strategy to collect important patient information.
One of the participants commented that “if written narratives (paper-based) give us the indices of what is wrong with the patient when we start a conversation, I can only imagine how much more effective audio and video narratives in EHRs can be. I admit it can help in decision-making, and it could also serve as a reminder in case some important information is left out during the treatment process of a patient” ” (OC10-PH3- r2.4). According to Thompson and Kreuter (2014), Adams, Robert and Maben (2015) and Briant et al. (2016), narratives can be captured in written, audio and video format.
Participant (OC10-PH3-r2.3) mentioned that “incorporating audio and video narratives in EHRs can provide health practitioners with a clear picture of what is wrong with the
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patient over a prolonged period. This will help in decision-making as EHRs have the capacity of summarising patient information on a screen which helps health practitioners in taking further action. An additional benefit to electronic narratives is that proof exists should “legal issues” (OC6-PH2-r2.2) arise between a patient and the healthcare institution. According to Wolderslund et al. (2015), digitally captured narratives in EHRs are relevant for recording important information of a patient with the purpose of adding value to the decision-making process, and serving as a reminder of past patient records in a clear and concise way.
Participants considered the functionality of recording patients’ narratives in EHRs “the best gift they can offer to their patients and to themselves” …since “most family members request for their relative’s EHRs (OC7-PH2-r2.2; OC8-PH2-r2.2). Most participants welcomed the idea of the inclusion of audio and video narratives in EHRs because electronic narratives can “increase willingness to communicate, can teach about cultures, can build empathy and can promote positive attitude” (OC7-PH2-r3.2;
OC8-PH2-r3.2; GP3-PH2-r3.2; PD2-PH2-r3.2). In a study conducted by Chesi (2018) on tools in narrative medicine, communication was enhanced between healthcare professionals and patients when tools such as free drawing and free written narratives were used during the diagnosis phase for patients who found it difficult to express themselves verbally. The author found that these tools can assist health practitioners to extract key narratives from patients and, when properly used, they contribute immensely to the decision-making process. Furthermore, there are tools used in audio narratives such as oral interviews, focus groups and forums that target a specific group of patients sharing similar diagnoses and health challenges.
There are however legal and ethical concerns that must be taken into consideration when incorporating narratives in EHRs (Russo et al., 2016). Patients’ narratives are confidential and the moment patients realise that they will be recorded, “it may change the dynamic of their stories and create trust issues” (PD1-PH1-r2.3). According to Fioretti et al. (2016), a change in patients’ stories can affect decision-making since patients’ treatment depends on their narratives. The moment patients do not openly and freely narrate everything related to their health issues, the decision-making can result in the administration of wrong drugs and/or
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treatment. The authors added that to avoid such incidents, healthcare professionals must make patients aware of the importance of their narratives.
It is evident from the findings that narratives in EHRs are still at the infancy stage in private oncology care in Cape Town. Wu and LaRue (2017) emphasise that the implementation of EHRs to support healthcare service delivery and decision-making can be complex due to issues such as high costs of implementation, security and privacy vulnerabilities, legal barriers to IT adoption, and the lack of appropriate policies and regulation. Furthermore, the absence of data standards still makes it difficult to benefit from the meaningful use and integration of narratives in EHRs for decision-making.