The electronic health record was welcomed with mixed reactions by providers, patients as well as legal professionals who have to deal with medical records on a regular basis. One of its perceived advantages is that it can facilitate processes such as medical claims review and medical records review because of the ease of sharing the records among various entities. However, it seems to have triggered some negative results as well. EHRs may negatively impact patient-physician encounters and interaction. This has been established in a study that employed a qualitative analysis of comments from hospital-and office-based physicians.
The study – Rhode Island Health Information Technology Survey – was conducted in 2014 by the state’s Department of Health, and the analysis of comments was done by researchers at Brown University and Healthcentric Advisors. For this study, 744 doctors provided feedback regarding their EHR use and the impact it had on their interactions with patients. The study results were recently published in the Journal of Innovation in Health Informatics. The interesting finding that emerged is that there is a difference between how in-patient physicians view their EHRs and how it affects their actions, compared to office-based physicians. Hospital-based physicians admit that EHRs have benefits such as better information access, improved patient education and communication. However, they are concerned about the EHR’s unintended negative consequences.
- Hospital-based physicians commented most frequently that they spend less time with patients and more time on computers to meet documentation requirements.
- Office-based physicians said that EHRs worsened the quality of their interactions and relationships with patients.
The study found that other responses also differed across different settings. Hospital-based physicians more frequently comment on the use of the electronic health record to feel more prepared for the clinical encounter. Office-based physicians on the other hand, comment on the change in workflow, and the depersonalization of relationships.
Rebekah Gardner, an associate professor of medicine at Brown University’s Warren Alpert Medical School and a senior medical scientist with Healthcentric Advisors has the following observations on this topic.
- Different solutions may be required to improve how electronic health records are used in in-patient versus office-based settings because doctors in those settings perform their jobs differently.
- Hospital-based physicians more often use computers placed outside of patient rooms, whereas office-based physicians typically bring laptops into exam rooms.
- Since outpatient doctors tend to document and go through the EHR while they are talking to the patient, they may not be able to maintain eye contact with the patient, and appear distracted. Doctors should avoid doing this. They should ideally not turn on their computer immediately on entering the exam room; instead they should focus on giving total attention to patients and engage them in conversation.
- An effective way of including patients also in EHR documentation is to turn the computer screen in such a way that patients can also view it. Doctors can narrate what they are doing in the EHR so that patients feel involved in the documentation process.
- Inpatient physicians see patients on hospital floors, the ER and the ICU – settings where the computer is often not there. They go outside of the room and document at a later time. The study team reports that when doctors use computers for EHR documentation in in-patient settings, it limits time spent directly interacting with patients.
Technology should not detract from the patient experience. The patient should not feel that the provider spends too much time with the computer and less with him/her. In such cases they may not return for subsequent appointments and this could be an issue especially for patients with chronic conditions. Other issues also exist. Patient volumes may decrease over time if patients leave the practice/hospital for another organization. It could result in damage of reputation if patients express their disappointment or dissatisfaction to their family, friends or other providers. This could further lead to a drop in referrals and decline in revenue.
The Rhode Island Health Information Technology Survey throws light on the heavy and voluminous documentation related to EHR as well as the clumsy EHR user interfaces. Therefore it is vital to make EHR interfaces more intuitive and reduce the documentation burden on physicians. On the provider side, to experience the benefits of a good EHR system and minimize risks, providers should carefully balance technology with the human element during patient visits. EHR technology should be capable of enhancing the patient experience and improve care standards, not reduce it.