Preserving the Human Element When Adopting an EHR
Author: Ishwara N. Sharma MD FACC, Chairman, MedNet Medical Solutions
As clinicians, our focus, first and foremost, is on how we can take excellent care of our patients. When a patient comes to see the care provider, he or she expects the provider's undivided attention and a compassionate audience. The providers are professionally trained and mentally conditioned to conform. No issue.
With the advent of electronic health records, or EHRs, and the multitude of technological devices invading the exam room, clinicians are dealing with numerous challenges in accepting the technology without sacrificing the quality of care. As they spend time fiddling with their keyboards and mice, or staring at their screens, they may be turning more and more impersonal, if not outright robotic, to their patient in the room.
While the benefits of electronic health record are well documented and less and less contested over the years, the fear remains that EHR adoption may be accelerating the alienation between the doctor and the patient. How can the providers take advantage of the technology without losing the personal touch with their patients? Will the technology be a boon or a bane? Does it hinder the doctor-patient relationship rather than enhance the experience?
These are all legitimate questions. As a practicing physician as well as an architect of an EHR product suite, I want to share my personal experiences as to how I think this problem can be mitigated by following a few simple steps.
There are certain features your EHR product must offer to help you do your job efficiently without sacrificing the human contact with your patient. The technology you choose should act as your companion in the exam room to aid you in your work rather than disrupt the flow and interfere with your relationship with the patient. Secondly, I'd like us to not get carried away by technology, but stick to the basics of patient care. Let us consider the technology itself first.
Five Features You Should Look for in Your EHR Product
In order to spend more time with the patient, we need to spend less time documenting the visit process. Your EHR product should come equipped with a few features that help produce speedy and accurate documentation, and thus free up time for the patient.
Customizable visit templates that follow your workflow rather than the other way around.
Doctors have spent years perfecting the way their clinical flow works for them and their staff. A new EHR system should not sabotage that process and force you to rework the flow. The EHR application should allow for flexibility and customization for each unique user. You may tweak your workflow to gain efficiency, but never have to derail something that you have painstakingly put in place and perfected over a number of years.
Library of frequently used forms that are easy to create, modify and maintain. Whether it is a standard form or a unique form to your office, the EHR application should provide the capability to create and upload your forms to a central location within your system for use when needed. You must be able to easily access those forms, quickly copy-paste content from them, make edits and save, all with just a few clicks. You should not be limited to the "standard" forms provided by your vendor, or, even worse, depend on the vendor for creating or modifying the forms to suit your particular needs.
Customizable physical exam, review of systems or history of present illness (HPI) templates based on the individual provider's style of examination. There are areas within the clinical encounter, such as, the physical exam, review of systems, and even the HPI that should allow the provider to customize to reflect the phraseology he or she is most familiarly using. Does the EHR system require you to document your examination a certain way, or does it allow you the flexibility to do things the way you are used to?
Easy, intuitive navigation. Ability to get to any screen with as few clicks as possible. No one has the time to delve into endless drill-downs and mouse-clicks to capture the data for their daily clinical encounters. The time you spend doing so is the time you are not spending with your patient. The EHR application should provide quick access to the relevant functions needed day in and day out within a click or two. The ease of use will not only promote prompt adoption and acceptance among you and your staff but helps you spend more face-time with your patient.
Let us take the physical exam. Different providers might document a simple observation in different ways:
Similarly, each provider may have a unique way of framing his or her questions to the patient as well as choosing the systems to be reviewed. The questions and systems for an internist are very different from those for a specialist. You should expect the EHR to allow you to follow your style and flow rather than box you into a canned way of conducting your business.
By letting you retain your own style of functioning, the EHR allows you to maintain your natural rhythm in interacting with your patients, and the system simply follows you.
Ease of documentation via mouse-clicks, keyboard strokes or sound bites - or a combination thereof, seamlessly integrated. Today's technology has given us endless means to accomplish the same task. Your EHR application should not limit those options, and should offer the flexibility to input data through any of those means, or any combination of typing, clicking or voice dictation. You don't have to exit out of one application to open another one to be able to do this; it should be seamless. Having the flexibility to use the mode of entry that works best, and the ability to effortlessly switch among those modes, allow you to maintain an unhindered workflow in the exam room, which helps you look at the patient more than you stare into a computer screen.
Now, having examined a few EHR features that can help a physician maintain or enhance his or her human contact with the patient, let me point out a handful of common-sense tips that can come in handy, with or without the technology.
Five Common-Sense Dos and Don'ts For Preserving The Human Touch with Your Patient
Listen, listen and listen. As we all know, there is no substitute to listening. Rather than open the computer and start viewing the screen or typing from the get go, listen to the patient's narrative of concerns and respond to them in a meaningful way.
Maintain eye contact. You should try to arrange the furniture in the room to help maximize face time with your patient throughout the encounter. You want to try to maintain some degree of face-contact with the patient even when you are typing, mouse-clicking or viewing the screen.
Have your patients participate in the process. Think about the idea of involving your patient in the visit process. Discuss what you are doing in the system, allow them to take a peek at the monitor, and show them one or two elements of the documentation process. For example, if you show your patient how the computer "remembers" what you said or did to the patient a year ago, it might go a long way in the patient gaining confidence in the technology. You want to make your patient feel that this odd gadget is not taking you away from them, but rather is helping the two of you have a more productive interaction.
Have up-to-date information available prior to seeing your patient. Make sure that the patient record is up-to-date. Your staff should enter routine information before you see your patient rather than you spend time looking for the details after you start your encounter.
Use dictation extensively. With the strides made in voice-recognition technology, you can get a good voice recognition solution for about $150. If your EHR system accepts the voice input, great. Even otherwise, you can have someone transcribe your speech later and add the notes to the record. By keeping your hands off your computer, you will be able to give your patient the undivided attention they have come to expect.
As healthcare providers, we are under constant pressure to optimize our time and care while producing speedy and accurate documentation. It behooves us to balance these priorities, and use technology in ways to help deliver quality, compassionate care without turning ourselves into impersonal robots.
*Dr. Sharma welcomes you to share your own experiences on the topic. He can be reached at firstname.lastname@example.org.