Electronic medical records have many benefits, and certainly a future where a patient's medical record travels with her from facility to facility, improving coordination and reducing duplicative care, is a desired one. However, many providers who are going through or have completed electronic medical record implementation in their offices have certainly realized a few drawbacks. The most obvious of which, at least to providers, is a change in workflow that can reduce productivity. However, there is another impact that directly affects patients: changes to the patient-provider interaction.
EMRs affect the patient-provider interaction significantly, starting first with the physical elements of the interaction. A provider now has either a tablet, desktop or laptop computer where information must be entered, and depending on how the exam room is designed, it could lead to the provider having his or her back to the patient for most of the interaction. One study found that in some interactions, the provider had his or her eyes on a computer screen (as opposed to the patient) for 50 percent of the interaction.
Additionally, while many physicians have long used templates to guide documentation, the number and detail of templates within EMRs could cause physicians to treat patient interactions as a string of checklists rather than an opportunity to build rapport and listen to a patient's narrative about his or her illness. A more detailed description of an illness provided through a narrative could provide valuable information that might otherwise go unstated by the patient. According to a physician quoted in an 2010 New York Times op-ed by Pauline W. Chen, MD:
"'Physicians think in stories,' said Dr. C. T. Lin, a practicing internist and chief medical information officer for the University of Colorado Hospital in Denver, which has used electronic records since 1994. 'How can you possibly point and click your way through a patient’s 10-year history?'"
Because of EMRs' potential negative impact on patient-provider interactions, providers must be careful to not let technology distract them from a personal interaction with patients.
Unfortunately, many best practices in this area are established by commonsense rather than evidence. While using commonsense best practices is better than keeping your back to the patient, more research should be done to examine how to best interact with patients and an EMR.
Some research suggests that EMRs can improve patient-provider interactions if providers engage patients with the computer screen — for example, to confirm information entry, view lab results and/or explain digital images.
While we wait for more research in this area, a commonsense approach to engaging patients and entering information into EMRs is helpful. For an example of what not to do, see this video below on how not to use an EMR.
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How have EMRs affected your practice and interactions with patients?