# Improving Patient Care and Physician Resilience through Effective Veteran-Centered Communication and Documentation Practices

> **NIH VA I01** · RLR VA MEDICAL CENTER · 2021 · —

## Abstract

Background: Electronic medical records (EMRs) serve a variety of purposes in healthcare, from disease
management and pharmacy order entry, to billing, reimbursement and population-based research.
Increasing organizational pressures for throughput, including strict time requirements for completion of
documentation, have resulted in unprecedented cognitive and communication challenges for primary care
clinicians as “people work” (providing care) and “paper work” (EMR completion) vie for attention in the exam
room. Though the patient/clinician relationship remains “the center of medicine” conceptually, the patient/
clinician/ computer relationship adds the challenge of simultaneously inputting data into the EMR to the task
of patient centered communication. These competing demands often result in multi-tasking, which threatens
both the quality of the patient/clinician relationship and the accuracy of documentation. As well, failure to
complete patient notes by the end of the visit or regular business hours may shift the burden of
documentation from the workplace into the home where it competes with family time and self-care. Either
way, the EMR challenges clinician resilience, defined as successfully negotiating, managing and adapting to
significant sources of stress.
Objectives: The overall objective of this proposal is to optimize Primary Care Clinicians (PCCs) use of
computer-based technology in managing the administrative burdens of preparing for, enacting and
documenting ambulatory visits. The specific aims are to: 1) identify EMR documentation practices that relate
to high quality Veteran centered, well- documented care that is satisfying on both sides of the stethoscope;
2) describe the range of strategies highly effective clinicians use to prepare for, enact, and complete visit
documentation; and 3) test the feasibility of adapting an existing EMR curriculum for use with VA PCCs.
Methods: This is a multimethod project. For Aim 1, we will describe variations in exam room computer use.
Documentation completion rates will be calculated using available administrative data and ethnographic
observation. Clinicians’ real-time preparation, and post visit documentation during business hours, will be
observed and patient visits will be videotaped and analyzed. Aim 2 will identify clinicians’ EMR practices
associated with Veteran-centered communication, documentation accuracy and resilience. Measures
include: EMR accuracy and completeness, clinicians’ psychological resilience, and Veterans’ perception of
patient centeredness. The results will be triangulated with the ethnographic observations and video recorded
encounters. Cognitive task interviews will be utilized to understand the mental models used to guide
decisions about how, when and where PCCs use the EMR and how these models relate to perceptions of
resilience. Aim 3 will test the feasibility of adapting an existing EMR curriculum for use with VA PCCs.
Innovation: The proposed project breaks ne...

## Key facts

- **NIH application ID:** 10125823
- **Project number:** 5I01HX002519-03
- **Recipient organization:** RLR VA MEDICAL CENTER
- **Principal Investigator:** RICHARD M. FRANKEL
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2019-01-01 → 2022-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10125823

## Citation

> US National Institutes of Health, RePORTER application 10125823, Improving Patient Care and Physician Resilience through Effective Veteran-Centered Communication and Documentation Practices (5I01HX002519-03). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10125823. Licensed CC0.

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