Recently, I stumbled across a very interesting article talking about I call the “patient alienation effect” generated by EMRs. The author, Charles Smith, who practices at the University of Arkansas, is an EMR old hand who has been using the Centricity ambulatory EMR for more than a decade.
The article, which appears in the Journal of Participatory Medicine, talks about the well-known offputting effect EMRs have on patients, and the frustration that they impose on doctors. And as readers know, we’re not talking about a minor impact here.
In the new EMR world, he notes, physicians have a list as long as your arm of EMR related tasks they must perform during the patient visit, including medication reconciliation, managing the problem list, e-prescribing, updating the patient’s history, review of systems, physical exam, entering the follow-up plan into the record, and printing “after the visit” summaries for the patient. And as he points out, this all has to happen for the patient is still sitting in the exam room.
The way he handles this problem is to treat the challenge is one for the patient and physician to solve things together:
* At the outset, he and the patient have an open discussion of the EMR issue with new patients, discussing the advantages and challenges of the computer in the room.
* Then, he asks the patient’s to allow him to move their chair beside him in the computer, noting that they will “all three” work together during the visit.
* He also tries to create a hybrid experience of completing some EMR tasks during the visit and others after (for example telling the patient, “hold on while I enter this order for you) before returning to face-to-face conversation.
* He finds that it works best to take notes here and there during the patient visit, then complete the past medical, surgical, family and social history and the review of systems together with the patient directly in the EMR.
Obviously, there’s no one right way to integrate patients into the process of documenting their visit in an EMR. But these ideas seem like good ones.