What works: Patient-physician relationships or electronic health record information in planning healthcare delivery for patients with disabilities?

While much research has examined physician and patient satisfaction with the use of Electronic Health Records (EHR), little research has examined how EHRs can be used to prepare for delivering healthcare to patients with disabilities, nor these patients’ satisfaction regarding how their accommodation needs are met. A federally qualified health clinic in California added disability accommodation questions to their electronic patient database. This study reports an analysis of their utilization of this information. The data were collected from 4 focus groups with 28 doctors, nurses, physician assistants, and front office staff, and from phone interviews with 12 patients with disabilities. Qualitative analysis of the focus groups and interviews using NVivo indicates that despite healthcare staff having advanced documentation of patients’ disability-related needs, lack of systemization remains regarding how to handle complex accommodations, many of which are done “on the fly”. Both staff and patient interviews indicate that meeting patient needs was a more efficient and comfortable process when a staff-patient relationship existed. Additionally, patients’ expectations regarding disability accommodations were rooted in their perception that their physician and clinic staff knew them, not because accommodation information was documented technologically. Patients’ satisfaction with healthcare experiences seemed to be more strongly related to their perception that their needs were known and understood by the clinic staff, rather than presence of specialized equipment. These findings indicate that despite the potential for advanced planning that EHRs may offer, human relationships remain vital in facilitating safe and satisfactory healthcare experiences for people with disabilities.