One of the most common complaints heard about the use of electronic health records (EHRs), is that clinicians don’t know how to successfully interact with both patient and computer in the exam room. Many health care professionals worry that their patient visits will end up looking something like the one in this video, which demonstrates what a doctor shouldn’t do when using an EHR system during a patient encounter:
A 2010 study by the Center for Studying Health System Change, a nonpartisan policy research organization in Washington, D.C., found that EHR systems both “help and hinder” physician interpersonal communication. EHR systems provide a wide range of benefits, including instant access to patient information, but they also have a huge potential for distracting clinicians and pulling them away from face-to-face interaction with the patient. The study concluded that office workflow modifications and communications skills training can help with having an EHR system in the exam room without hurting clinician-patient interaction.
So, where does a health IT professional begin in designing the perfect EHR-enabled, patient-friendly exam room? The Center for Health Information Technology offers only scant advice on setting up exam rooms with EHR technology. An article from the Medical Office Today website provides a bit more detail on how to integrate EHR technology with an exam room, and suggests that exam rooms may need to get bigger to accommodate the hardware required for EHRs.
Another helpful guide for setting up EHR-enabled exam rooms comes from Lumetra, the Medicare Quality Improvement Organization for California. Lumetra advises using the acronym LEVEL to help providers understand the basics of patient interaction during the office visit:
Let the patient look on.
Eye contact with the patient.
Value the computer as a tool.
Explain what you are doing.
Log off and say you are doing so.
The Lumetra guide notes that setting up the exam room properly is very important for organizations using desktop computers, but less important for those using laptops or tablet devices. The guide also provides three sample layouts that incorporate computers, keyboards and monitors, and lists the advantages and disadvantages of each one.
Once your EHR-enabled exam rooms are all set up, be sure to train clinicians to use them in a way that doesn’t leave patients feeling dehumanized. For example, maintaining eye contact is an important part of clinician-patient communication, according to Lisa Gualtieri, adjunct clinical professor in the health communication program at Tufts University School of Medicine in Boston, in a post offering clinicians some practical EHR etiquette advice on the e-Patients.net blog.