“Are You Even Listening?” How Your EHR Could Be Killing Your Patient Relationships
By Jordan Miller, MD
You’re at lunch with a close friend whom you haven’t seen in some time. It’s an opportunity to catch up, share what’s been going on, and participate in some meaningful dialogue. And yet your friend is constantly looking at his or her phone – occasionally glancing up at you as you’re talking as if they are listening. As the person speaking, you can only assume that they’re only half-listening to what you’re saying as they type away. Sound familiar?
A similar scenario is extremely common these days in physician offices. The use of EHRs has been both a blessing and a curse as it relates to patient engagement. In a recent study by Brown University and Healthcentric Advisors aptly titled, “It’s like texting at the dinner table:” A qualitative analysis of the impact of electronic health records on patient-physician interaction in hospitals,” researchers found the use of EHR systems negatively impacts the quality of physician-to-patient interactions.
The study is based on a 2014 Rhode Island Department of Health survey that asked 744 physicians open-ended questions including, “[h]ow does using an EHR affect your interaction with patients?” The increase in reporting standards and the amount of data that physicians need to report today have resulted in valuable time being diverted from the patient. Instead of the physician and patient maintaining eye contact during the examination, the computer tends to be the focal point. This tends to create an uncomfortable and often cold experience for the patient, and leaves the physician feeling unfulfilled.
This increase in demand for data also attributes to physician burnout* – where the physician works tirelessly to treat patients while keeping up with the day-to-day documentation in the EHR and subsequent reporting. Even the AMA has raised concerns about EHR usability.
While this ripple effect impacts all levels of the healthcare system, it is the patient who suffers the most. With reportedly high levels of physician burnout across the US – between 50 and 75 percent of physicians, by some reports – coupled with poor engagement due to using technology in the exam room, patients get the short end of the stick when it comes to achieving their health and wellness goals.
Shouldn’t medical professionals work as efficiently as possible while improving patient outcomes? With the shift to value-based healthcare and the focus leaning now more on patient outcomes, the answer should easily be yes. But, as we’ve seen from many studies, it’s not that simple. But it should be.
Technological advancements today have positively impacted so many industries, including healthcare (e.g. connected devices, robotic surgery), so why is some EHR technology still lagging?
As a practicing dermatologist, I can attest to the ever-increasing need to document patient information in a way that is usable. If physicians don’t have the right systems and technology in place, it could potentially take a lot time and effort to not only keep a practice up and running, but also make it successful. For years, documenting in a paper chart was the standard, and some physicians still prefer this method. Then it transitioned to what was essentially documenting in a word processing system on a desktop computer. In neither situation is the data collected in a structured way or able to be used for medical wisdom, or collecting and extracting this data to show the physician statistically what might lead to better patient outcomes. Plus, with these methods I had to frequently stay late in the office and bring work home – taking time away from the patient, and from my family.
Throughout my conversations with other healthcare providers, I’ve learned some physicians argue that improving patient relationships starts with the creation and adoption of intuitive technologies that can automate key administrative tasks and simplify documentation during patient visits. Healthcare providers should have an EHR system that improves their daily professional lives and, when it comes to usability, is intuitive and knowledgeable about my specialty, plus saves me time.
In fact, in the aforementioned survey, doctors did recognize that EHR systems can provide benefits to patient interaction related to the easy access to a patient’s history. Other physicians commented that Web-based patient portals improve communication with patients, and some shared that they will often utilize their computers to bring up and display educational illustrations of medical conditions. From the study, it can be assumed that the physicians who bring their EHR system and laptops – or iPads – into the exam room have identified ways to turn a potentially detrimental patient engagement situation into a positive one.
I like to think that I’m a perfect example of a physician who utilizes EHR technology that not only saves physicians time, but also helps improve patient outcomes. Today I use a native iPad platform that’s intuitive, automatically adapts to my preferences, collects structured data, codes patient encounters using the touch-based system and automates outputs. I can reference a longitudinal visual timeline of a patient’s diseases and treatments, allowing me to easily determine if a patient’s conditions are improving or declining over charted time periods. The mobility of the iPad allows me to show my patients exactly what I’m reviewing and use it as an educational tool. It’s technology designed to improve patient engagement and clinical outcomes. Everyone wins.
From a business standpoint, data-driven platforms help make practices more profitable and save time. Health IT systems should allow physicians to document exams while the patient is in the exam room, use that data to automate reporting, automatically generate billing codes with modifiers based on your notes, show your current billing level in real time, and assist with daily operational tasks including referring physician letters and faxes. As precision increases, so could profits. Technology should improve operational and financial outcomes, while at the same time improving patient access and outcomes – and yes, even eye contact.
*If you’re a physician or medical practitioner experiencing signs of physician burnout, there are many helpful resources on the American College of Physicians website.
Jordan Miller, MD is a dermatologist at Northern Arizona Dermatology and senior medical director of dermatology at Modernizing Medicine in Boca Raton, FL.