Doctors and patients complain about EHRs, and often for the same reasons. Both say that doctors who use EHRs spend too much time typing and looking at their computer screens, rather than on focusing on the patient’s needs. But with a little planning and forethought, EHRs can actually improve doctor-patient communication and cause both parties to see them as a valuable tool for improving care.
That was the message Wei Wei Lee, MD, MPH, assistant professor of medicine at the University of Chicago’s Pritzker School of Medicine, delivered at the American College of Physicians 2018 Internal Medicine Meeting in New Orleans.
“We know when the EHR is not integrated well into the visit, the computer can be seen as a distraction from the patient-doctor relationship, and we also know that there are ways of using the computer as a tool to enhance communication and improve the way we use it for patient education,” she said.
In her session, “Computer and Patient: Competition or Collaboration?” Wei discussed research she and colleagues undertook a year after the Pritzker School and its clinics adopted EHRs, looking at how use of the computers affected patients’ perceptions of their doctors. The results surprised them.
“We found that overall patients regarded EHRs as a really positive presence in the exam room,” she said. “Patients liked that their primary care doctors could see notes from other team members. They knew that really improved their care.” On the other hand, patients didn’t like the lack of transparency that accompanies EHRs, such as not knowing what information doctors were entering into the computers.
Their research led Wei and her team to develop a set of best practices for using EHRs to enhance patient-centered care. They distilled their ideas into the acronym HUMAN LEVEL:
• Honor the first minute of the patient encounter: It sets the tone for the rest of the visit, by talking to the patient and not using EHRs or any other form of technology.
• Use the “triangle of trust”: Create a triangle configuration in the room that allows the physician and patient to both view the EHR and the physician to address the patient.
• Maximize patient interaction: Allow time by encouraging the patient to ask questions if they don’t understand something.
• Acquaint yourself with the patient’s chart: Reviewing notes and other pertinent information before entering the exam room
• Nix the screen: When a patient starts discussing a sensitive or emotional topic, turn away from the EHR screen and look only at the patient.
• Let the patient look on while entering information into the EHR: Doing so not only helps build trust with the patient but ensures the accuracy of the information because the patient is there to confirm it.
• Eye contact: Maintain it as much as possible throughout the visit.
• Value the computer: Talk about the benefits of the EHR, and make it a tool for engaging patients by jointly reviewing data such as lab results and specialists’ reports. “If you display negative emotion towards EHR that can leave a lasting impression that isn’t good,” Wei said.
• Explain what you’re doing: Be open about everything you’re doing with the EHR in the patient’s presence.
• Log off: Signing off of the patient’s chart while the patient is present helps reassure them that their information remains private and won’t be viewed by anyone else.
Videos in which Wei and her colleagues discuss these practices in greater detail are available online at www.thedoctorschannel.com.