Changing The Dynamic Between EHRs And Patients

By Roland Therriault, President, InSync

EHRs have long been the culprit of waning patient satisfaction. But they don’t have to be.

Most physicians have been using an EHR for at least five to ten years. But while it’s been a decade since the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act introduced the term “meaningful use,” physicians still complain about the technology.

One of their biggest qualms is that EHRs interfere with patient relationships by creating a technological barrier that de-personalizes consultations in the exam room. While this complaint is admittedly less rampant than in 2010, it’s still far too common for physicians – even those on their second, third or fourth EHR.

A study published in the journal Family Medicine revealed that family practice clinicians spend more time documenting within their EHR than they do directly interacting with their patients. Inevitably, this means they’re engaging less. And as studies like this one suggest, engagement is directly correlated with patient satisfaction.

A separate 2017 study published in the Journal of Innovation in Health Informatics equated EHR use to “texting at the dinner table,” and showed that while physicians see value in EHRs, it’s not without cost to the relationship with the patient: Office-based physicians were more likely than their hospitalist counterparts to comment on EHRs worsening the quality of their interactions and relationships with patients.

These data raise important questions, as to why — in an era of communications technology — physicians are still struggling to balance patient interactions with electronic communications. Is it their EHRs or other technology systems? Or is it the physicians themselves, who refuse to seek out a system that supports their workflows?

Communication Breakdowns

To understand why EHRs are still creating a rift in patient-physician communications, it helps to first understand the importance of such relationships.

Since the dawn of medicine, patients have turned to primary-care doctors in sickness and in health. The family medicine practice setting is the one place — or one of the most important places — where all health concerns can be vetted with a professional, without judgment, who offers guidance and direction.   

In the practice setting, physicians and other healthcare providers who smile frequently, maintain eye contact and express enthusiasm and energy consistently receive high marks. Physicians who spend more time with patients and don’t try to rush through visits are the most popular, highly rated doctors in the country — regardless of whether the quality of care they provide is simply good or truly exceptional.

Also, while patients are regularly inundated with communications technology, when they visit the doctor they expect professionalism, engagement, concern and even enthusiasm in return.

When a physician spends a good portion of a patient visit industriously typing medical notes into a computer, checking off prompts, sending electronic prescriptions or engaging in other tasks, the patient potentially loses out on meaningful interpersonal time. There’s less, eye contact, encouraging smiles and other reassuring gestures, before the patient is ushered back to the waiting room.

These might seem like small differences between now and the 1980’s, but they make a big impact in a patient’s perception of the visit, the doctor, the care and the overall experience.

Raising The Communications Bar

The combination of the right technology, workflows and communication strategies, can amend many of communication issues resulting from EHRs.

The following three strategies are still the most important when using an EHRs during a patient visit and communicating with them.:

• Engage immediately. First impressions mean a lot. Don’t enter a room with an electronic device in front of your face as you greet anyone, especially a new patient. Look alive, smile, and shake a patient’s hand, as you always have.
   
• Integrate the EHR into the visit. When using an EHR to document care, always face the patient. When typing notes, look up from their computer screen occasionally to ask questions, pausing as needed. It should go without saying that when a patient begins talking about a sensitive topic, it’s time to turn away from the EHR screen.
   
• Keep documentation simple. The EHR that you use should support your workflow, streamline decision-making and improve efficiency. If an EHR requires that a physician answer 15 questions in order to diagnose a simple stomachache or laceration, it may be time shop around for something new – like a smarter EHR with prompts and screen that support your typical workflows.
   
• Seek specialty solutions. Medicine is highly specialized, so the EHR that works for a hospitalist or internal medicine doctor may fall short for a behavioral health provider or OB/GYN. Work with a vendor that offers cloud-based technology solutions tailored to your specific demographic.

EHRs, like smartphones, aren’t going anywhere. This is a good thing, as electronic documentation and record-sharing enables physicians to provider higher-quality, more patient-centered, efficient care. But your EHR should enhance — not detract from — the patient care experience in your medical practice.

Times may have changed but patients still expect their providers to be fully engaged and professional. Technology’s ultimate purpose is to support physicians so they can support their patients’ emotional and physical needs at and between every single visit.

About The Author

Roland Therriault is President of InSync.