Are You Taking The Time To Look Into Your Patients' Eyes?

It’s more important than ever before as the use of computers could take the human element out of care encounters.

By Ben Nwoke, MD, MBA, COO, DEMA/DMCG

A study reported on by JAMA Internal Medicine showed patients are less likely to rate their doctors as “excellent” when the physicians have their noses buried in their computers. A troubling conclusion — considering the fact that healthcare industry leaders have been pushing doctors to use electronic health records (EHRs) for the past few decades.

The answer, however, is not to give up the electronic fight but to find a way to use these systems more effectively.

“Healthcare has become increasingly electronic and documentation based, and in that process, we’re losing the ability to just engage with people as human beings,” said Nicole Eull, PsyD, a psychologist who provides physician coaching and training in her role as the Director of Behavioral Medicine for the University of Wisconsin’s Department of Family Medicine and Public Health Residency program at Aurora Healthcare. “We need to hold onto our humanity and our ability to connect with other people, because face it, no one got into healthcare to be a data entry expert. People chose healthcare careers because they want to help other people.”

Fortunately, we have discovered here at Diabetes Endocrinology & Metabolism Associates, Charlotte, N.C., that it is possible for physicians and other staff members to use EHRs in the exam room and simultaneously form very human connections with their patients. In fact, we are using a certified EHR from RevenueXL and fully engaging patients by encouraging all of our clinicians to follow a variety of best practices such as:

• Putting patients first. Making a strong connection with patients is the most important part of the patient visit. As such, we advise our clinicians to start each exam by purposefully connecting with the patient — a practice that also is recommended by Eull.

“You can’t enter data and look at the person at the same time. But it is possible to give the patient 90 seconds of your complete attention. Make eye contact and really try to hear what the patient’s concerns are. If you just give them these first 90 seconds, there’s an overwhelming amount of evidence that patients then feel heard and they rate their practitioners as more competent. All it takes is just listening for the first part of the patient encounter,” Eull said.

• Selecting and implementing an EHR that, in accordance with recommendations from the 2014 National Institute of Standards and Technology (NIST) report, Integrating Electronic Health Records into Clinical Workflow: An Application of Human Factors Modeling Methods to Ambulatory Care, is designed to allow for “empathetic body positioning and eye contact with the patient while personally interacting with the EHR and while sharing information on the EHR screen with the patient and family members”.

To achieve this positioning clinicians need to “move the patient and the electronics around so that you can still look at the person,” Eull said. To accomplish this, medical practices can rely on triangle formations that place the physician, patient and computer monitor or device at each of the three corners, allowing the doctor to give equal attention to both the EHR and the patient.

• Engaging the patient while using the computer. To fully engage patients, we encourage our doctors and other clinicians to explain what is happening on the computer screen at all times, instead of merely typing away while the patients wait in silence. For example, clinicians could mention that they are entering the patient’s vital signs and checking to see if there had been any significant changes since the last visit. By doing so, clinicians might spark conversations with patients about weight, blood pressure or various other topics.

It’s also a good idea for clinicians to allow patients to actually look on while they are entering information into the computer. As such, the patient will feel as if they are taking part in the care process, and might even correct errors.

• Separating routine data entry tasks from the patient visit. We encourage our physicians and other clinicians to perform routine data entry tasks either before or after actual patient encounters. As such, medical assistants frequently enter basic information before patients actually walk into the exam room. When the patient enters the exam room, then, the physician is prepared to immediately start talking about the pressing health concerns.
   
• Training physicians to use the system. It’s important for doctors to understand how to use the computer — and the various applications, especially the EHR. As such, we work with our physicians to make sure they are comfortable actually using the system. If physicians wind up spending a lot of time looking for information or trying to find where to enter data, then patients are likely to become quickly alienated.

• Encouraging physicians to tout the value of the EHR. “Physicians should talk to patients about — and attempt to gain their support of — the electronic health record. For example, clinicians can talk about how useful the EHR is to patient care, highlighting features such as e-prescribing and the accessibility of historical health data. By doing so, patients are more likely to make the connection between the EHR and improved clinical care.

Beyond Engagement In The Exam Room
EHRs can also be leveraged to go beyond simply connecting with patients — and to actually better engage patients in their clinical care. Dubbed as the blockbuster drug of the 21^st Century, “patient engagement” holds the promise of improved health outcomes, better patient care, and lower health care costs. Such engagement is of great value as it stimulates positive patient behavior, by providing real time patient education and by facilitating shared decision making with clinicians.

We have already started to use technology to better engage patients here at Diabetes Endocrinology & Metabolism Associates. For example, patients can remotely access their electronic health record at any time. More specifically, they are able to become more engaged in their care by accessing a patient portal that enables them to:

• request appointments
• check status of scheduled appointments
• review lab results (after discussing the same with physicians)
• request prescription refills
• complete the medical history forms
• view messages sent by physicians and other clinic staff members

We plan to continue to push the patient engagement envelope, though. For example, we are exploring the possibility of providing connected devices to patients, which will enable us to start to collect data in real time to monitor patient health remotely via the EHR. For example, we could supply patients with remote glucose monitoring devices. As such, clinicians would be able to review glucose levels in real time — and work with patients to make medication and lifestyle adjustments that better control their diabetes.

Such interventions will make it possible to make to transform the patient care experience. Instead of merely providing healthcare services to patients, we will be able to partner with patients and engage them in the healthy behaviors that will ultimately help them improve clinical care outcomes.

About The Author
Ben Nwoke, MD, MBA, is the COO of Carolinas based DEMA/DMCG.  For more information on EMRs and EHRs from RevenueXL, go to: www.revenuexl.com.