Does EMR Implementation Decrease the Amount of Time a Physician Spends Talking to a Patient?

I soon found myself spinning and wheeling back and forth between patient and computer, and when my patient did talk, his story came only in spurts because every time I turned my back to him to type, the room fell silent.

The results of a new investigation from the Center for Studying Health System Change (CSHSC) reveal a possible complication of electronic medical records (EMR) implementation: Will the immediate accessibility that an EMR provides to patient information decrease the amount of time a physician spends interacting with a patient?

The new study involved interviews with clinicians in 26 physician practices. Although EMR make real-time communication with patients easier, particularly because of immediate access to patient information, they can also be a distraction during visits. Dr. Pauline Chen, author of the “Doctor and Patient” column in the New York Times, reflected on the results of the study, a problem she has already experienced.

“The new computer was perched atop a desk in one corner of the room; the patient sat on the exam table on the other side of the room. In order to use the computer, I had to turn my back to the patient as I spoke to him. I tried to compensate by sitting on a rolling stool but soon found myself spending more time spinning and wheeling back and forth between patient and computer than I did sitting still and listening. And when my patient did talk, his story came only in spurts because every time I turned my back to him to type, the room fell silent.”

According to the CSHSC study, for all of the benefits that an EMR system provides, such as access to a patient’s medical history that decreases the need for questions about lab work and test results and more time for patient-physician interaction, there are as many problems. Included in the CSHSC study were physician concerns about how EMR will change the practice of medicine:

Less communication with patients

“… My concern now is that we’re listening less because we have more information when we walk in the room, and it’s not all trustworthy,” said one internist.

Solving complicated cases

One cardiologist interviewed by CSHSC said, “If I am implanting a defibrillator, the primary care physician may have some thoughts about the patient’s true life expectancy that might influence our decision-making process about whether the device is appropriate for the patient…we need to do a better job [of communicating orally], because we [cardiologists] can’t do it without input from the physicians that understand the patient’s complex chronic conditions.”

However, the researchers believe that continued maintenance of the EMR system will eventually maximize the effectiveness of the tool, and they provide several suggestions for improvement in their report.

“Overcoming EMR-related challenges to interpersonal communication will likely involve continued refinement of their design by vendors and use by clinicians to decrease the potential for distraction during the patient encounter,” the researchers wrote. “Efforts around health information technology implementation at the federal and clinical practice level might incorporate training to improve interpersonal communication skills for practitioners and medical trainees in the presence of an EMR. The modification of office processes and clinical workflows to maximize interpersonal communication while using an EMR is also likely to be helpful.”