The use of electronic health records interrupts the doctor-patient connection

The utilization of electronic health records during the patient encounters has the potential to negatively affect the doctor-patient connection, in accordance with a study that used a qualitative analysis of comments from hospital- and office-based physicians.

Researchers at the institute of Brown University and Healthcentric Advisors conducted the analysis of comments, which were submitted in response to a Rhode Island Health Information Technology Survey, conducted in 2014 by the state’s Department of Health—744 doctors gave feedback about their EHR use and how it impacts the doctor-patient connection.

“We were actually struck by the difference between how the inpatient physicians view their EHRs and how it affects their actions, in contrast with those in the office space,” claims Rebekah Gardner, MD, an associate professor of medicine at Brown University’s Warren Alpert Medical School and a senior medical scientist with Healthcentric Advisors. Result of the research was recently published in the Journal of Innovation in Health Informatics.

Researchers discovered that hospital-based physicians commented most frequently that they spend less time with sufferers because they have to spend more time on computers for documentation. By contrast, office-based physicians commented most frequently on EHRs worsening the quality of the doctor-patient connection.

“However hospital-based physicians report benefits ranging from better information access to improved patient education and communication, unintended negative consequences are more frequent themes,” the researchers wrote.

The research discovered other responses differed across settings. “When comparing themes across settings, hospital-based physicians more frequently comment on the use of EHRs to feel more prepared for the clinical encounter, while office-based physicians more frequently comment on alteration of workflow and the depersonalization of relationships.”

At the similar time, the authors point out that comments from physicians that were “generally positive and comments that detailed the sufferer’s perspective comprised the least commonly observed themes for both (hospital and office) settings.”

In accordance with the Gardner, the study demonstrates the requirement for different solutions to make better how EHRs are used in inpatient versus office-based settings, given the different ways in which doctors in those environments perform their jobs.

She points out those hospital-based physicians frequently use computers situated outside of patient rooms, while office-based physicians increasingly bring laptops into exam rooms.

Outpatient doctors “will be documenting and going through the EHR while they are sitting there talking to the sufferer, so it is literally sitting there between them, distracting the physician from making eye contact and taking their attention away from the patient,” states Gardner, who suggests that doctors “honor the golden minute” when they first enter an exam room—not turning on their computer, giving patients their undivided attention and engaging them in conversation to develop doctor-patient connection.

She also suggests that after the computer is turned on, physicians should turn the screen in such a way that patients can view it. Doctors should “narrate” what they are doing in the EHR to be more inclusive of the documentation process, in accordance with Gardner.

On the other hand, Gardner claims inpatient physicians “who take care of patients on hospital floors, in the ICU and ER, when they are in the room with a patient, the computer often is not there—they are going outside of the room and documenting later.” As an outcome, researchers report that when doctors use computers for EHR documentation in inpatient settings, it limits time spent directly interacting with patients.

“With our inpatient findings, it actually speaks to the volume of documentation that is required and clunky EHR user interfaces,” states Gardner, who calls for making these interfaces more intuitive as well as decreasing the documentation burden on physicians.

Gardner and her colleagues appreciate that one of the limitations of the survey is that it was administered in a single state. Although, they contend that the large sample size, high response rate, range of represented specialties and array of EHR vendors might reduce this limitation.

 

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