Rethinking EHRs As Engagement Enablers

There are numerous problems with many EHR products on the market today that I accept as fact — they’re cumbersome from a data entry perspective, counter-intuitive to clinical workflows, and aren’t conducive to interoperability. However, one of the biggest physician complaints about EHRs is that the technology places a barrier between them and their patients, which negatively impacts interaction and engagement. This gripe I don’t buy. I just don’t see this issue being inherent to the technology, but rather a prime example of user error.

In my opinion, an EHR is no more a barrier between the physician and patient than a paper chart is. Even with paper records, most doctors are inclined to, at some point, bury their noses in the chart and scribble notes that patients never see. The notion of the paper chart as a barrier was illustrated perfectly in a 1996 episode of Seinfeld called “The Package” (http://bit.ly/1g1sPsp). Throughout this episode, Elaine tries to get a rash diagnosed and, in the process, becomes obsessed with seeing the information contained in her paper medical chart. Her attempts are thwarted by several different doctors who, in turn, confiscate the chart, scribble more private entries into her record, and then abruptly end her exam. Most scenarios parodied on Seinfeld are exaggerated observations from everyday life. Not exactly a ringing endorsement for the engagement attributes of paper charts, is it?

As with paper charts, most doctors bury their noses in a computer screen to enter orders into an EHR. However, “the barrier effect” of this activity is more pronounced with EHRs because of the increased data entry demands and the fact that many doctors aren’t experienced typists. Th at being said, I would argue that EHRs don’t have to be a barrier between physicians and patients, but instead could serve as the catalyst for engagement.

What if, instead of turning their backs to patients to type notes into a laptop, physicians positioned the computer screen to face patients and invited them to review, or even take part in, the data entry process? I am a patient in a doctor’s office that uses this approach, and the impact has been transformative.

In this particular ENT office, physicians display EHR screens on large 32-inch monitors affixed to the exam room walls. Rather than typing information into tiny desktop computers, laptops, or tablets that are for “doctors’ eyes only,” physicians record or update EHR data in full view of the patient — and often with their input. Seeing my patient record in full HD glory was an eye-opening experience. I was prompted to ask my physician questions and even identified errors in the information contained in my chart that the physician immediately corrected. More doctors need to stop viewing patient records as their private property and start involving patients in the creation, evolution, and maintenance of their medical information. EHRs can make this easier than ever before, and the benefits to patient engagement and wellness can be profound.