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Enhancing Physician Communication Skills while using an EMR. Does the patient really have to feel like the “third wheel”?
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Ann M. Grana,
LHE Senior Consultant
314.541.2220 | Email
With the advent of electronic medical records, the dynamic of the patient encounter is radically changed, which poses new challenges for physicians. A new member of the team is in the room – the EMR screen. How do we make this a useful addition and not an intrusion?
Prior to the widespread use of EMR, many health care providers felt it would take away the personal component of the relationship. It was believed that patients would not want to lose that eye-to-eye contact and be unhappy with a doctor who spent their time looking at a computer screen. Interestingly, most patients feel the opposite.
A Harvard study stated that “year after year, people have seen information technology transform one industry after another and, more to the point transform their everyday experiences.”
This is the age of the iPhone, Facebook and Google maps, yet health care feels very much the same. This study suggests that people are ready for a change – they want a modern health care experience. It found that patients want full access to their medical records and are willing to make some privacy concessions –they fully expect computers will play a major role in their medical care, even substituting for face-to-face care.
All healthcare providers want the system to be as patient-centered as possible while acknowledging that patients have broad and deep experience with technology in other sectors of their lives.
Consumers want the best health care possible and fully expect technology will play an increasingly important role in raising the quality of care, including monitoring their health and giving them real-time feedback, including communication with clinicians when needed. Participants also said they expect computers to act as “personal coaches and to foster self care.”
How important is communication? In a review of 363 malpractice cases from a recent study, it was found that the cause was attributed 27 percent of the time to communication errors, second only to medication related errors at 32 percent.
- clarifying information
- encouraging questions
- ensuring completeness at the end of a visit.
In December of 2011, Medscape reported, “Patients are more enthusiastic about reading what their physicians are writing about them than physicians are about allowing patients to access their electronic health records, according to a study published in the December 20 2011 issue of the Annals of Internal Medicine.
In the study, researchers led by Jan Walker, RN, MBA, from Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School, Boston, Massachusetts, surveyed patients and primary care physicians in Massachusetts, Pennsylvania, and Washington. There were 114 participating primary care physicians, and 37,856 patients completed surveys. The researchers surveyed physicians and patients before their admission in to a voluntary program that allowed patients access to physicians’ electronic notes.
The researchers asked physicians and patients about their views on patient access to personal health records that included physicians’ notes about visits, which patients accessed through a Web portal. The records also contained such information as prescribed medicine lists, appointment schedules, and secure messages.
“The enthusiasm of patients exceeded our expectations; most of them were overwhelmingly positive about the prospect of reading visit notes, regardless of demographic or health characteristics,” Ms. Walker and colleagues write. Although they observed “striking differences” between physician and patient attitudes, the physicians who participated in the study “were more optimistic” that access would improve benefits than the researchers expected. Physicians who declined to participate in the voluntary electronic records program cited possible adverse effects such as patient confusion, which could lead to longer visits.
What are the most successful providers doing to make this transition a successful one?
- Review electronic chart prior to walking in the room (some offices have desktops on the counters outside the pt rooms).
- Immediately engage the pt in viewing the screen with you
- Talk directly to the patient before opening the screen.
- Choose equipment that can be easily viewed by both physician and patient
- Physically orient the room for better communication
Clinicians believed EMRs facilitated communication with patients in a variety of ways . In general, immediate access to EMR data enabled them to focus on the patient rather than gathering information from a variety of paper sources during visits. As one physician explained, because “we do not have to call down the hall for a lab or test result, we spend more quality time [with the patient] in a more context-rich way.” Similarly, because staff can pose questions to the physicians via the EMR’s electronic instant messaging (IM) function, rather than opening the exam room door, doctor-patient communication during a visit can continue uninterrupted, at least physically.
Ease of access to information also enriched patient education during visits. For example, clinicians could pull up information from the patient’s record, such as the problem list, medication list and care plan, or educational information from the Internet to review on screen with patients and family members during the visit. Some respondents reported sharing copies of that information
For complicated patient situations, respondents believed nothing should replace the interactive aspects of face-to-face or phone conversations. As a cardiologist said, “If I am implanting a defibrillator, the primary care physician may have some thoughts about the patient’s true life expectancy that might influence our decision-making process about whether the device is appropriate for the patient…we need to do a better job [of communicating orally], because we [cardiologists] can’t do it without input from the physicians that understand the patient’s complex chronic conditions.”
EMR users cited several approaches to prevent EMRs from diminishing interpersonal communication with other clinicians and staff. For example, setting clear expectations with office staff on what is appropriate for electronic vs. oral communication is important. As several respondents noted, clinicians need to remind themselves, and the students and medical residents they help train, about the importance of face-to-face or phone conversations when indicated.
One physician explained the importance of discussing with staff the types of urgent or sensitive issues that should be communicated orally, such as notifying a physician about a patient’s arrival at the emergency department. “You have to use electronic communication when appropriate and voice when appropriate, and even paper when it’s appropriate,” he said
EMRs also foster a feeling among clinicians that patient information is a shared asset when they co-manage patients, as opposed to something one practice “owns.” A national expert commented that this improves interpersonal communication between clinicians because “EMRs move physicians away from the concept that, it [patient information] is mine and you can’t look at it. It should be shared for teaching and management purposes in a secure way.” 
For more information on specialized communications training programs, please contactAnn Grana at 314-541-2220 or ann@amgccc.com.
