Fears about the patient relationship
How do you handle fears that you are spending too much time looking at the computer screen rather than facing the patient?
How do you handle fears that you are spending too much time looking at the computer screen rather than facing the patient?
Answers
The first step toward resolving this issue is already done - you have recognized that the problem can exist. This problem can be avoided during the training phase of implementation by stressing that in many ways the EHR is the same as your paper chart, if you focused on writing and lost eye contact etc. on paper it is easy to do the same electronically. Train staff to ask questions, briefly enter data, ask more questions or complete an examination and then enter data. Hardware choice also plays a part, particularly if using a PC in the room as opposed to a laptop. Use articulated arms rather than a fixed mount, consider the exam table location when mounting the hardware and when applicable share the screen with the patient - use the EHR as an educational tool. Finally, don't let IT decide on hardware or mounting locations, treat these decisions as clinical not technical.
Using an EHR? Yes - NextGen EHR, EPM and EDR
Disclosure: No ownership or interest in any related business or association
You definitely need to structure the exam room so you are comfortable using the computer as you are FACING THE PATIENT. I have heard stories of those with hardwired systems in the exam rooms up against the wall - the doctor does the evaluation with their back to the patient. The essence of evaluating the patient is the doctor - patient interaction, not the doctor - computer interaction. If the latter were the case, you would hardly need the patient present - just have them phone in, use a webcam and ask them to press on their abdomen and tell you where it hurts/whether they feel splenomegaly.
Another key issue is learning your EMR. You need to become facile, maneuvering quickly through the system. The less time you spend figuring out which button to push, the more time you have to spend with the patient. In that context I will add that I prep my notes the night prior to visits so a majority of the note is ready and I am up to speed with what tests were recently done/what is due - that allows me to relax and focus on the patient rather than looking around the computer to figure out if they are due for an A1C or pneumovax.
Using an EHR? Yes - eClinicalWorks
Disclosure: Owner/practicing partner of Aquidneck Medical Associates, Inc. Contracted as the Case Management Physician Advisor at Newport Hospital (a Lifespan affiliate) and as an advisor for BCBS of RI to help facilitate HIT integration in community practices
First, you need to position your monitor so its in the general direction of the patient. DO NOT set it up with your back to the patient. Second, allow the patient to follow along with you. As you read the ECG, review the lab and xray reports, have the patient join in. Rather than alienating the patient you now have allowed them to join in and share the technology. Almost all patients really like this and are very impressed that their medical chart is so "high tech"! They particularly love watching the ePrescribing as you zoom off the Rx to the pharmacy and save them a trip to drop it off. Done right, it will actually enhance the encounter.
Using an EHR? Yes - EpiChart
Disclosure: President and CEO of Polaris Medical Managment