When I interact with my clients concerning EHRs, it’s typically on issues concerning integration or cost. As a health lawyer, I understand the privacy and technological benefits that EHRs promise to bring to a medical practice. In addition to being a lawyer, however, I am also occasionally a patient, and I recently had opportunity to experience an EHR in a practice that had only recently integrated.
This is how my experience went: My physician joined me in the examination room and sat down at a small desk and logged into a computer. She proceeded to ask me a variety of questions about the reason for my visit as well as confirming certain details of my health and background, pausing to type into the computer and take notes on all my answers. Her back was to me during the time she asked these questions. When she began the physical examination, it was interspersed with visits to the terminal. Finally, she completed her exam and data entry and led me to the waiting room. With a friendly smile goodbye, she moved on to her next patient.
Only when my physician interaction was completed did I have a chance to contemplate the experience. Not only did I feel the appointment was rushed (a separate issue), but the quality of the visit was diminished by the time my physician had spent at the terminal, turned away from me. I realized she had not looked me in the eye when we talked, nor asked me questions about my well-being, to encourage me to share concerns, or to feel I could confide in her. In fact, other than answering questions for the EHR, we had not talked at all.
After this experience, I wondered about whether providers are receiving the EHR training needed to properly integrate this technology into their practice. At a time when physicians’ reputations are so easily damaged by online reviews, doctors have a lot to lose if they fail to integrate EHRs in a manner that results in a positive patient experience. When I left my physician, I was not thinking about the short wait time or how quickly I was able to schedule the appointment. I was feeling I had been neither seen nor heard by my doctor and the feeling was negative.
I have talked with clients about modifying their internal EHR policies and training in order to improve patient interaction. Some of the ideas we have developed include the following:
1. Before turning away from any patient to enter information into the EHR system, let them know about your system and why you will be typing information they provide into the system. Explain the advantages EHRs bring to them as patients. Ask the patient if they are comfortable with the approach you are using and if not, find a solution.
2. Consider location of the EHR in the office: Is it proximate to the patient? Is it on desk that can be rolled toward the patient? Are handheld devices more conducive to effective patient visits in your particular office?
3. Watch for patients who seem to be struggling to hear you or see you, especially the elderly. It can be very upsetting and embarrassing to ask someone to repeat themselves repeatedly.
4. Pay attention to patients who seem inhibited or who need encouragement to confide in you. Some patients are looking for a certain level of intimacy with their physician to ask questions or share concerns and may feel uncomfortable. Providing comfort to patients may require repeated trips between patient and computer in order to have a successful medical visit.
5. Make eye contact with patients when possible, and repeat back their answers to them to confirm you are listening.
There are many ways in which physicians can tailor the introduction of EHRs into the practice setting to best meet the needs of its patients. With careful planning, EHRs can offer the privacy and technological advances it promises, without becoming a impediment to a successful physician-patient relationship. Make sure you continuously assess how your practice’s patients feel about an EHR so that you can turn it into the positive experience it can become.
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