Issue link: https://viewer.e-digitaledition.com/i/674098
2 3 M D N E W S . C O M /// M D N E W S L O N G I S L A N D ■ 2 016 2 3 M D N E W S . C O M /// M D N E W S L O N G I S L A N D ■ 2 016 TIME PHYSICIANS SPEND ENTERING DATA INTO EHRs DURING APPOINTMENTS MAY REDUCE PATIENT SATISFACTION, A RECENT STUDY IN JAMA INTERNAL MEDICINE SUGGESTS. MORE THAN NINE in 10 physicia ns who tra nsition to EHR s say it ma kes locati ng patient records more con- venient, according to a sur vey by the Of f ice of t he Nationa l Coordi nator for Hea lth Information Technolog y, a n a gency of the U. S. Depa r tment of Hea lth a nd Huma n Ser vices. H o w e v e r , r e s e a r c h b y N e d a Rata nawongsa , MD, MPH, A ssociate Professor, Division of Genera l Interna l Medicine and University of Ca lifornia, Sa n Fra ncisco Center for Vulnerable Popu l at ion s , a nd c ol lea g ue s i nd i- cat es pat ient s at sa fet y net cl i n ics view this facet of technolog y-driven ca re a s seconda r y to t he qua l it y of the huma n connection between them a nd t heir prov iders. Data col lected from 71 physicia n-patient encounters suggest patients perceive their ca re as excellent more of ten when huma n i nt era c t ion t a kes precedence over computer use. Only about 48 percent of patient s rated t he ca re a s excel- lent when computer use wa s higher, compa red with 83 percent who rated it excellent when there was less usage, according to the study. The researchers do not recommend banning computers from examination rooms. View ing a n EH R during a n appointment may, for instance, more readily reveal that patients and physi- cians have a diŽerent understanding of what medications patients should be taking, Dr. Ratanawongsa notes. That is an opportunity to educate patients and provide clarity regarding treatment. However, it is vital that the patient feel personally connected with the provider, she adds. The physician's tone as well as his or her willingness to engage in some small talk help a'rm that connection, she says — so long as a sense of sincerity comes through. "These conversations can be helpful for building rapport," Dr. Ratanawongsa says. "But if they are done while a doctor is typing on a computer and not really paying attention to what is being said, t hen physicia ns ca n a ct ua l ly m iss important information from patients." Eye contact is a simple but impera- tive component of EHR use during appointments, says Richard Frankel, PhD, Professor of Medicine, Indiana University Department of Medicine, who wrote a commentary in the issue of JAMA Internal Medicine in which Dr. Ratanawongsa's research appeared. "Eye contact between a physician a n d a p a t i e nt c onv e y s e mp a t hy," Frankel says. "It conveys interest. It conveys orientation." He adds that issues related to com- puter use during appointments extend to settings beyond just safety net clinics, and he recommends some best practices to help patients feel cared for while still allowing physicians to record medical data promptly: + Upon entering the exam room, phy- sicians should spend a few minutes chatting with patients before even turning to the computer screen. + Physicians should explain how the computer will be used during the appointment, noting, for example, its value in accurately recording important medical information. + Physicians should also make patients partners in the EHR process, allowing them to see the screen simultaneously with physicians. ■ Eyeing EHRs A 2014 study in the International Journal of Medical Informatics found that physicians gazed at EHRs for approximately 30.7 percent of the duration of patients' visits; patients viewed their EHRs for about 11.5 percent of their visits. PHYSICIAN COMPUTER USE during Appointments May Harm Perception of Care BY K AITLIN GUNTER P R A C T I C E M A N A G E M E N T 2 3