EHRs Enter Patient-Doctor Relationships

A study says the use of computers can strengthen or interfere with the rapport between physicians and patients.

When brought into the exam room, computers act as a kind of third member in the relationship between doctor and patient, concludes a study published in Annals of Family Medicine.

Whether the computer enhances or weakens the relationship depends both on how easy it is to use and how skilled physicians are in making use of it.

"Physicians were often conflicted between recording data in the EHR [electronic health record] and giving patients one-on-one attention," wrote the studys authors, led by William Ventres of Multnomah County Health Department in Portland, Ore.

/zimages/2/28571.gifIs optimism waning over EHRs? Read more here.

The researchers observed and videotaped physicians in four primary care clinics who were all using the same EHR system.

Relatively simple fixes could help doctors move from being data gatherers to caretakers. For example, most physicians walked straight to the computer monitor with only a cursory greeting to the patient.

Others, however, listened to a patients concern, and then tacitly asked permission to use the computer to review previous notes.

According to the study, the EHR seemed to affect the quality of the notes physicians took during encounters; compared to dictated notes, notes recorded in EHRs seem to include less detail about patients concerns and situations, information that doctors need to persuade patients to adhere to recommended medical regimes.

In a separate study published last year, Richard Frankel of Indiana University and colleagues found that doctors who were already skilled communicators could use EHRs to enhance discussions with patients, but that EHRs kept less-skilled communicators from paying attention to their patients.

/zimages/2/28571.gifRead more here about the relationship between doctors communication skills and the use of EHRs.

Some problems that occurred had more to do with the computers than with the physicians. Screen templates used to collect information worked well for simple, straightforward problems, but did not capture patients emotional issues or help manage patients with multiple, interacting conditions.

Although physicians did not always think to use screens this way, mobile screens can allow physicians and patients to look at data together. Giving physicians access to the EHR while on call, in the office, or at the hospital was also productive. Because information could be entered during any "encounter," researchers wrote, "the EHR gave physicians and patients the sense of seamless communication."

Frankel praised the current study. He said the study, which classified four "domains" of how doctors use and perceive EHRs, could give engineers a framework for designing better systems.

Frankel also said Ventres study showed how doctors need to change their own frameworks for using EHRs. For example, trainee physicians interviewed by Ventres team balked at learning patient communication and use of EHR simultaneously. Frankel said the young doctors were making an "artificial distinction."

"These resident physicians arent thinking of the EHR as a communication tool, as much as typing up information," he said, adding that physicians will need specific training to change that mindset. "The medical record for so many years has been the private domain of the physician, and the notion of using it as a shared document is relatively new."

The Annals of Family Medicine study is available here as a PDF. The researchers also wrote tips for physicians using EHRs that include showing patients information on screen and recording their concerns and situations.

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