- Healthcare professionals have been challenged with balancing EHR use and patient engagement during the clinical encounter as technology has evolved over the past 20 years.
Providers face significant regulatory requirements for EHR use and reporting and now have to document patient charts on their computers. With the Medicare and Medicaid EHR Incentive Programs, money is on the line.
But the focus on clinician EHR use does not erase the need to create a positive patient experience. Instead, it creates more challenges.
How can doctors create strong patient relationships when there was a computer distracting them? How can nurses have time to talk with patients when they had to document a patient encounter?
Although providers have come a long way with integrating the EHR into the patient encounter, they still face many challenges. A 2017 study published in the Journal of Innovation in Healthcare Informatics showed that both office- and hospital-based providers struggle to overcome the distractions and barriers arising from EHR use.
Hospital-based clinicians struggle with making time to visit each of their patient exam rooms for check-ins and relationship-building. These providers fear they are not making connections at a high enough frequency.
Conversely, office-based clinicians fear the quality of their patient interactions is waning. Office-based clinicians typically do not have a personal office in which to document patient encounters and therefore use the EHR during the appointment. Providers fear this is distracting or isolating for the patient.
Healthcare professionals must develop a set of strategies that work with their patient populations to drive better overall patient engagement. Providers can overcome EHR challenges by using workflow changes, educating the patient about the technology, and taking a minute for technology-free relationship-building.
Identify and implement workflow improvements
Integrating the EHR into the healthcare encounter has been a significant disruptor of clinician workflow. Clinicians now must input patient data into the digital chart, taking away from the time they could spend chatting with patients and building relationships.
Several providers have created workflow shortcuts to better integrate the technology into the patient encounter. Although not perfect, these workarounds allow clinicians to chart and fulfill the EHR duties more easily.
A 2015 clinician survey published in the Journal of the American Medical Informatics Association identified many workflow changes clinicians have made to make EHR integration easier. Some providers chart between office visits when possible. This strategy tends to lend itself to clinicians who have a separate office from their exam rooms.
Other clinicians use charting templates. Having a somewhat standardized form on which clinicians can plug in patient information makes the process of charting quicker.
“I have a template for new patients and I always follow the template because it keeps me organized and it keeps me on track,” one respondent said. “Otherwise if I just do a free form I’ve tried then I forgot this, I forgot that, oh I didn’t ask about allergies or something and so when I follow my template it’s very good because it has a rhythm to it and I never forget anything and so I like it that way.”
Charting templates must be flexible and cater to specific patient needs, however. Industry experts also caution against copy and pasting patient information from chart to chart because that practice creates many patient safety and data integrity questions.
Show and tell the patient about EHR usage
The EHR is not something that is leaving the healthcare industry; clinicians and patients will need to contend with the technology for the foreseeable future. Because of that, it is important that clinicians help familiarize their patients with the EHR.
One 2015 study published in the Journal of Family Practice found that when used correctly, patients can grow to like the EHR and the technology can improve patient satisfaction. The key is ensuring patients know what the EHR is being used for and understand its importance.
“Patients found it disturbing not knowing what their doctor was doing when he or she worked on the computer, and preferred being able to see the computer screen,” the researchers found. “This study suggests that it’s advisable for clinicians to describe what they are doing when they use the computer, so that patients better understand how this time spent inputting data actually benefits them.”
Providers should turn and share the screen with their patients to allow patients to see and understand what the EHR is and how it’s being used.
Respondents in the JAMIA article also stated that they like to let patients in on the EHR’s utility. Addressing the elephant in the room helps familiarize the patient with the tool and reminds patients that their clinician is not ignoring them when the clinician is typing.
“When I see new patients, one of the first things that I tell them is I need to type and look at the computer while I talk to you because that’s how I can make sure that the information here is the most accurate and how I can provide you with the best care possible,” one respondent said.
Take a moment away from the computer
Using the EHR during the clinical encounter is nearly impossible to avoid. There are major regulatory requirements for EHR reporting, and it would be extremely difficult to use the tool exclusively outside of office hours. However, providers still need to take a moment completely free of technology use.
Known as the “Golden Minute,” this moment should be rooted solely in building relationships with patients. Although clinicians are notoriously pressed for time, industry leaders suggest doctors and nurses alike still take at least a minute to make a deeper connection with patients.
“There is so much to do, so much to accomplish, so many checklists to fulfill that the connected nurse is going away and becoming a lost art,” explained Press Ganey CNO Christy Dempsey, MSN, CNOR, CENP, in a previous interview. “I wanted to help nurses understand that it doesn’t take more time to connect. Instead, it’s how nurses connect that makes a difference.”
Clinicians should focus on quality, not quantity, when it comes to patient-provider communication. In doing so, clinicians can allow enough time to integrate the EHR into their workflows while still allowing for a strong relationship with the patient.
Studies suggest that taking a moment away from the computer has a positive effect on the patient experience. A 2015 analysis of patient perceptions of care quality among office-based EHRs showed that providers who spent less time looking at their screens yielded higher patient satisfaction.
Forty-eight percent of patients who experienced a care encounter with high computer usage rated their care as excellent. This compares to 83 percent of patients who experienced an encounter with low computer usage who rated their care as excellent.
These trends may be because clinicians miss out on a chance to make a deeper connection with patients while they are using the computer. When providers can reduce their EHR and screen time, they increase their chances of making a meaningful connection with their patients.
In a perfect world, clinicians and patients could both benefit from the efficiency and safety benefits of EHRs and build strong patient-provider relationships with no challenges. However, providers do have a regulatory imperative to focus on EHR use and documentation.
EHR use does not preclude providers from focusing on a positive patient encounter. As such, providers should create workflow efficiencies, explain the EHR to patients, and take a moment away from the computer to drive better patient interactions.