Improving Quality of Care
Electronic Medical Records (EMRs) are here to stay, but do they result in better clinical outcomes and improved quality of care for patients?
A recent survey conducted by Stanford Medicine and The Harris Poll found that nearly two-thirds of physicians believe EMRs have indeed improved overall patient care. But the survey results also uncovered signs of physician concerns.
Almost half responded that EMRs presented more challenges than benefits. The survey found that 62 percent of the time doctors are supposed to be spending with the patient is actually spent focused on the EMR. Half of office-based primary care physicians believe that the use of an EMR “actually detracts from their clinical effectiveness.1
Another survey of 3,400 physicians by The Doctors Company, showed that nearly half of the respondents believed EMRs had a negative effect on the physician/patient relationship.
Challenges of the EMR
Electronic Medical Records have been around for decades, but the passage of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009 significantly spurred their adoption by including incentives for healthcare organizations to implement health information technology. Today, nearly all healthcare organizations use some form of EMR.
However, the initial transition to electronic records focused more on billing and coding functions, rather than on the clinical care requirements of providers. This has gradually changed over time and EMR applications are increasingly being designed to aid doctors and nurses in their interactions with patients. Challenges still exist because of lack of interoperability between health care IT systems and excessive data entry requirements that detract from physician focus on the patient.
The patient point of view
A recent study found that physician focus on information on the computer screen may adversely affect key components of patient/provider communications and lead to patient dissatisfaction. The distraction may even affect adherence to treatment, clinical outcomes, and patient trust.
The study discovered that non-verbal communication, including eye contact, is as crucial to the success of the engagement as verbal communication. Eye-gaze demonstrates that the provider is paying attention and is actively involved in the engagement. Decreased eye-contact as a result of the EMR distraction can negatively impact health outcomes
Researchers have found that one way to reestablish the critical engagement connection is by sharing the computer screen with the patient. This not only improves the patient experience but also encourages shared decision making, enhances patient understanding and involvement, and minimizes patient feelings of being marginalized in the exam room.3
In the past, the patient could be the center of attention through that visit. Now, the physician is really dividing their attention between putting in orders and working in the computer without paying full attention to the patient.
A survey of patients at the University of Chicago medicine found that although most understand and approve of the need for EMR, many felt the focus of their engagements with providers had shifted toward the computer rather than to them. As a result of these findings, the university added a curriculum to teach physicians how to use EMRs in a patient-centered way. This includes sitting side-by-side with the patient with the screen in front of them both, instead of between them. The training also includes encouraging patients to speak up if they feel they aren’t getting the proper attention.4
The importance of active listening
There is growing acceptance in the physician community that despite the increased lab and test data, the key to accurate diagnosis of disease and illness is actively listening to the patient. Active listening requires seeing things from the patient point of view, something that is difficult to do if the caregiver is distracted physically or mentally by a computer-based EMR.
Active listening by a clinician leads to a more complete understanding of a patient’s condition. It also reassures the patient that the physician is paying attention and taking into consideration the important information the patient is relaying. It’s difficult for the physician to provide that kind of focused attention if the EMR computer screen is acting as a barrier that disrupts important doctor/patient communication.
The days when the medical axiom ‘listen to the patient – he is telling you the diagnosis’ was widely accepted and appreciated seem to be giving way to ones where doctors are stuck behind screens rather than at the bedside.5
Reconnecting Doctors and Patients
The demands of the EMR with entering and retrieving data during a patient engagement forces caregivers to focus on their computer screen at the expense of their patients. The StableRise® helps solve this problem by enabling the healthcare provider to remain patient-facing for better eye contact, nonverbal communication, and interpersonal social cues. The amount of time the provider spends focused on the patient instead of the computer screen enables superior care delivery, improves the patient experience, and builds a long-lasting patient/provider relationship.
StableRise® has been installed in medical centers across the U.S. and allows doctors and nurses to maintain the critical personal connection with patients during an exam. Doctors, nurses, and patients work best together when they communicate, engage in focused conversation, and grow the trust that is critical to enhanced quality of care.
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- EMR Effect on Quality of Care Still a Concern, Can be Addressed, Relias Media, January 11, 2019
- The electronic elephant in the room: Physicians and the electronic health record, by Philip J. Kroth, Nancy Morioka-Douglas, Sharry Veres, Katherine Pollock, Stewart Babbott, Sara Poplau, Katherine Corrigan, and Mark Linzer, NCBI, PMC, US National Library of Medicine, National Institutes of Health. May, 2019
- How physician electronic health record screen sharing affects patient and doctor non-verbal communication in primary care, Onur Asan, Henry N. Young, Betty Chewning, and Enid Montague, ScienceDirect, March, 2015
- When a doctor’s screen time distracts from face time with patient, by Carmen Heredia Rodriguez, Physicians News Digest, July 25, 2019
- The clinical value in listening, by Abraar Karan, Boston Globe, August 9, 2019