Tuesday, January 22, 2013

Tips for Focusing on the Patient in the EHR Exam Room

It has been a long time since my last post. My work passion continues to be: helping physicians and their practices successfully implement an EHR, connect to an HIE, and achieve Meaningful Use. I spent over a year addressing several major challenges in my life and now I look forward to be back working on making meaningful contributions that help to deliver quality patient care.

The other day, I had a discussion with a friend who is a cardiologist with a very illustrious healthcare leadership career. He expressed his concern about how the quality of healthcare appears to be decreasing. During the course of our conversation, he told me a story about one of his patients who went to a specialist recommended by him. The patient said that the specialist spent about 1 minute examining him and then spent the rest of the time in the exam room with his back to the patient asking questions and typing the answers into his computer. My friend was appalled by the poor, impersonal physician-patient interaction in the exam room and he alluded to the EHR as being the cause of the problem.

Unfortunately, this scenario of physician-patient interaction in the exam room has been repeated too many times. In addition to being detrimental to developing a good physician-patient relationship and to fostering good communication by observing body language, it also contributes to alienating physicians from wanting to use EHRs.

The goal of EHRs is to provide a tool that helps to improve the quality of patient care. The challenges faced by physicians who use EHRs in the exam room include:
  • becoming comfortable and proficient at using a computer as a pen and paper replacement
  • incorporating the computer into an effective exam workflow so that the computer enhances communication with the patient rather than diminishing it
  • adjusting to a new way of working that realizes benefits that were unattainable in the past
Overcoming these challenges requires an investment in time, hard work, and persistence. Consequently, many physicians are understandably very stressed when they transition to using EHRs especially when more time is often very scarce. The EHR road needs to be paved with excellent training in much more than just the technology - the hardware and the application software. A successful and smooth transition to an EHR environment mandates the inclusion of training on how to deal with change and how to create a new, highly effective workflow that improves upon the old manual environment and does not just mimic it in an automated fashion.

As part of a clinician's EHR training curriculum, it is important to discuss and practice ways to stay focused on patient communication in the exam room. There are some very helpful ideas proposed in the July 23, 2012 "How to communicate well with a patient while working on an EHR" article in the American Medical Association's amednews.com. The article describes the LEVEL system which was designed by Kaiser Permanente to help clinicians use an EHR in the exam room. LEVEL stands for:
  • L: Let the patient look on
  • E: Eye contact
  • V: Value the computer
  • E: Explain what you are doing
  • L: Log off
Larry Garber, MD, an internist and medical director of informatics at the Reliant Medical Group in Worcester, MA created a YouTube video explaining the LEVEL system. The video gives "good clinician" and "bad clinician" examples. The video is called "Physician Exam Room EHR Etiquette, Fallon Clinic" and can be viewed by clicking here.

Much continued success in providing your patients with the best possible care!

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