Issue link: https://viewer.e-digitaledition.com/i/674833
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 physicians who transition to EHRs say it makes locat- ing patient records more convenient, according to a survey by the Office of the Nationa l Coordinator for Hea lth Infor mation Technolog y, a n a gency of the U.S. Department of Hea lth and Human Services. H o w e v e r , r e s e a r c h b y N e d a Ratanawongsa, MD, MPH, Associate Professor, Division of General Internal Medicine and University of California, San Francisco Center for Vulnerable Populations, and colleagues indicates patients at safety net clinics view this facet of technology-driven care as secondary to the quality of the human connection between them and their providers. Data col lected from 71 physicia n-patient encounters suggest patients perceive their care as excellent more often when human interaction takes precedence over com- puter use. Only about 48 percent of patients rated the care as excellent when computer use was higher, compared 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 room s. View i n g a n EH R du r i n g a n appointment may, for instance, more readily reveal that patients and physi- cians have a different 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, then physicians can actually miss important information from patients." Eye contact is a simple but impera- t ive component of EH R use du r i n g appointments, says Richard Frankel, PhD, Professor of Medicine, India na University Depa r tment of Medicine, who wrote a commentary in the issue of JA M A Internal Medicine in which Dr. Ratanawongsa's research appeared. "Eye contact between a physician and a patient conveys empathy," Frankel says. "It conveys interest. It conveys orientation." He adds that issues related to computer use during appointments extend to set- tings 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 w i l l be used during t he 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 2 6