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•Designing an EHR that promotespatient- and family-centered care.

PATIENT- AND FAMILY-CENTERED CARE (PFCC) plans, de-livers, and evaluates healthcare grounded in mutuallybeneficial partnerships among healthcare providers, pa-tients, and families. Beaumont Health, a not-for-profitorganization in Michigan, has a strong commitment toPFCC, so when we determined that no straightforwardway (other than free text notes in the electronic healthrecord [EHR] or on paper) to capture meaningful pa-tient preferences existed, we created a nursing goal toidentify patient preferences more effectively in theEHR. Achieving this goal would help us support com-passionate connections among team members and pa-tients and famillies.

We met our goal by designing and launching theMy Story summary page in our Epic patient portal andEHR. This communication tool helps Beaumont team

members get to know patients by documenting theirpersonal preferences. We’ll look at how EHRs can sup-port PFCC and the steps Beaumont took to create andlaunch My Story.

Thoughtful EHR designEHR design has focused on capturing objective data,such as lab values, medications, and allergies. It’s beenless focused on capturing and analyzing data basedon patient preferences and concerns. Research, how-ever, has demonstrated that personal connections (es-tablished through preferences) with patients and fami-lies are valuable in all clinical settings.

A sophisticated EHR can best meet a patient’s needsif it supports care that’s evidence-based, sensitive, andspecific to the patient’s personal, educational, and cul-tural context. The key to realizing an EHR’s full poten-tial to promote PFCC is to design it to direct patientsand clinicians to record and share meaningful informa-tion. Thoughtful EHR design can facilitate a more pa-tient-centered clinical encounter. In addition, a patient-centered EHR can extend to quality-improvementprojects and research activities.

My Story: Supportingcompassionate connections By Miriam S. Halimi, DNP, MBA, RN-BC, and Dana Snyder, MBA, MLSCM(ASCP)SHCM

Mind/Body/Spirit

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Ranking preferencesWhen designing Beaumont Health’s Epic electronic health record My Story summary to incorporate patient preferences, we surveyedpatient and family advisors to determine what types of preferences should be emphasized and to rank them by importance.

Q1 My story

My preferred name

Where I live

My interests andhobbies

My occupation

My spiritual careneeds

My emergencycontact

My support person

Person who helps at home

What is mostimportant to me

My goal for the day

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

n Not important n Somewhat important n Very important

4% 16% 80%

28% 60% 12%

24% 52% 24%

16% 48% 36%

8% 40% 52%

4% 8% 88%

16% 84%

4% 20% 76%

4% 13% 83%

4% 32% 64%

Q2 My personal preferences

Not important

Somewhat important

Very important

n Diet (ex: other options for leafy greens)

n Special requests (ex: extra blankets/pillow)

n Education methods (ex: practice, video, print)

n Family/significant other communications (ex: my daughter, Rosie, should be present)

n Discharge planning (ex: my wife, Sue, should be present for home information)

n Advanced care planning (ex: documents on file)

n Values and beliefs

15% 15% 23% 8% 23% 8% 8%

12% 23% 16% 7% 11% 14% 18%

15% 10% 13% 18% 17% 13% 13%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

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The My Story storyMy Story reinforces a culture that embraces the four coreconcepts of PFCC—respect and dignity, informationsharing, participation, and collaboration—by creatingand influencing ongoing connections between patients

and the healthcare team. Patient preferences were de-fined so they could be integrated into the patient chartand communicated to alternate sites of care (primarycare offices, home health, skilled nursing facilities).

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Patients are empowered to share as much information as they want about themselves as part of the My Story questionnaire. Eachquestion has goals related to improving communication and promoting patient- and family-centered care (PFCC).

Component Explanation provided to patients/clinicians PFCC purpose

I prefer to be called Tell us what you’d like to be called when you visit a Respect the individual’s choice Beaumont Health hospital or clinic.

My interests and hobbies Tell us what you like to do and what interests you. Form a connection through personal include conversations

Occupation Tell us what type of work you do. Association with patient’s passions, but also for medical use

My family includes the Tell us who’s in your family. The patient defines his or her family, whichfollowing people supports PFCC principles

What’s most important to Tell us what’s most important to you when you’re in a Patients have a life outside of the hospital me while in the hospital Beaumont Health hospital/facility. that may cause them anxiety while in an acute setting

What I need most from the Tell us how your Beaumont Health care team can help The patient recognizes that we healthcare team during you while you’re in the hospital. acknowledge their fear and anxiety andmy hospital stay care about their personal well-being

Special requests Let us know of any special requests you may have, When possible, create an atmosphere that and we will do our best to accommodate them. resembles the patient’s home or primary care setting

Food and drink Tell us about your likes and dislikes, where you like to eat, Form partnerships between patient and if you need any help with eating or drinking, or if you nutrition services to best meet the patient’s have a special diet. needs and preferences

Sleep and rest Tell us about your usual routines and what helps you to Help establish or preserve personal habits rest or relax. We can offer some aids while in the hospital. to promote success after discharge

Personal preferences and Tell us about your normal routine, any help you need, Help establish or preserve personal habits self-care and your preferences. to promote success after discharge

Getting around Tell us how you usually get around indoors and out, any Help form partnerships with care walking aids you use, or difficulties you have moving management and physical therapy staff around.

Maintaining my Tell us about things you prefer to do for yourself and Establish trust and promote success after independence how we can help you be independent. discharge

Significant events Tell us about recent or upcoming significant events that Build relationships or use during care are important to you. planning to support the patient and allow for follow-up before and after the significant event

My Story questionnaire

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Understanding preferencesBeaumont’s PFCC model regards the experiences andideas of patient and family advisors (PFAs) as essen-tial to the sustainability and delivery of healthcare pro-

grams. PFAs are patients and family members whohave received care within Beaumont Health and volun-teer their time to help improve the care experience.Based on recommendations from several PFAs, Beau-

My Story reportThe My Story report can be completed, in consultation with the patient, by any member of the care team. For ease of use, it can beaccessed through hyperlinks located in summary pages, through the admission and shift navigators, and from the toolbar.

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mont surveyed PFAs across the system to gather in-sights about the meaning of preferences, what types ofpreferences should be emphasized, and which aremost important, based on a ranking system (See Rank-ing preferences.) After the initial survey, PFAs and clini-cians continued to provide guidance and feedback todevelop My Story.

Additional input was provided by the corporate nurseexecutive council, multiple site-based nursing practicecouncils, the spiritual care council, several patient andfamily advisory councils (PFACs), and physician councils.

Design The My Story design incorporates both myBeaumont -Chart (Beaumont’s Epic-based patient portal) and EpicHyperspace to share information entered by either thepatient or the clinician. The patient portal empowerspatients to share as much or as little about themselvesas they choose. (See My Story questionnaire.)

My Story includes several foundational guiding prin-ciples and workflow considerations: • Capture patient preferences that cross care sites. • Include information that’s not likely to change across

encounters (such as preferred name).• Invite patients to complete nonspecific visit ques-

tions in myBeaumontChart before care.• Use hyperlinks to take clinicians directly to the flow-

sheets to add information.• Ensure all Epic users have access to the My Story

summary page.• Leverage information that’s already collected.

My Story uses the first-person statements “Gettingto know me” and “Meet my family” to help cliniciansthink about the patient’s story from his or her pointof view. One section, “My Daily Life,” is specific tomyBeaumontChart for only patients to complete; sim-ilar information is captured in the clinical assessment.

My Story can be completed by any staff member whohas contact with the patient and family. Although nurs-ing plays a significant role in My Story, the system al-lows connections to grow and flourish among all careteam members.

During patient care, My Story information can bedocumented in several ways, including through the ad-mission and shift navigators and the hyperlink withinthe My Story summary page for clinicians who don’tuse flowsheets. Hyperlinks also are placed within sum-mary pages to encourage using My Story during hand-offs. The My Story report is accessible from the start-upbuttons on the toolbar or can be pulled in through thewrench icon, which provides clinicians with the full listof report options. (See My Story report.) To honor pa-tient preferences, special attention has been given tooutpatient sites to ensure ease of use of My Story andto promote its use throughout the health system.

ImplementationTo maximize communication, resources, and staff en-gagement, My Story was promoted and launched withseveral other projects that blended well with the work-flow. My Story components aren’t required in the clini-cal workflow, but PFAs who piloted the myBeaumont -Chart My Story questionnaire shared feedback (whichwas communicated during clinical team training) aboutthe importance of clinical staff reading, reviewing, andusing the information when caring for patients.

The successful implementation of My Story depend-ed on partnerships and collaboration among teammembers in internal communications, informatics, nurs-ing, service excellence, and providers. They all had akey role in its design and launch. Because Beaumont isa large system with many sites, the team provided ed-ucation and awareness through newsletters, huddlemessages, intranet postings, and six webinars hostedacross multiple shifts and weeks to accommodate manyschedules. Post-webinar materials, including a link torecorded webinars, talking points, and screenshots, arestill available as resources and training tools.

Results and next stepsWithin 2 weeks of the go-live date, patients completedover 350 Getting to Know Me questionnaires throughmyBeaumontChart. Additional data will be collected todetermine rate of usage by clinical staff, as well as re-sponse rates for completion of the voluntary data andPress Ganey satisfaction data. My Story data may be re-quired in the future, but it currently remains voluntary.

Requests have been made for additional elements tobe added to My Story, including LGBTQ patient prefer-ences and veteran status. Continuing collaboration withpatient and family advisors and staff will determinewhich content will be incorporated as the tool is usedmore broadly.

Nurturing connectionsKnowing who a patient is as a person encourages trust,creates a PFCC culture, and produces better patientoutcomes. My Story blends information technology re-sources and PFCC principles to create and nurture con-nections that lead to care that aligns with individualpatient desires.

The authors work at Beaumont Health in Southfield, Michigan. Miriam S. Halimi isvice president and chief nursing information officer. Dana Snyder is program man-ager of patient- and family-centered care.

Selected referencesInstitute for Patient- and Family-Centered Care. ipfcc.org/about/pfcc.html

Nusbaum NJ. The electronic medical record and patient-centered care.Online J Public Health Inform. 2011;3(2).

Snyder CF, Wu AW, Miller RS, Jensen RE, Bantug ET, Wolff AC. Therole of Informatics in promoting patient-centered care. Cancer J.2011;17(4):211-8.