- Office- and hospital-based clinicians alike are saying that clinician EHR use is getting in the way of their patient interactions, according to a study published in the Journal of Innovation in Healthcare Informatics.
Healthcare professionals began adopting EHRs in an effort to reduce medical errors and streamline health data, putting the industry on the digital map of the 21st Century. However, as EHR use and requirements grew more prevalent, clinicians became increasingly concerned about the effects that these tools would have on the patient-provider relationship.
Through documentation requirements and policies in the Medicare and Medicaid EHR Incentive Programs, clinicians have seen an increase in the amount of time they needed to spend on their computers, potentially getting in the way of their interactions with patients.
“Many studies suggest that EHRs negatively impact patient–physician interactions; for example, physicians with EHRs spend more time on documentation, potentially leading to less time with patients,” the research team explained.
“Physicians may communicate less effectively when using EHRs, perhaps due to time spent looking at the computer, more keyboarding and less time for conversation and periods of silence during the consultation while physicians enter data,” researchers continued.
While some research has explored the effects of clinician EHR use on the patient encounter, results are inconclusive and limited to office-based interactions.
The research team used the 2014 Rhode Island Health Information Technology Survey to compare perceptions of EHR use for office-based and hospital-based clinicians.
The team looked at answers from 2,567 clinicians, 969 of whom were hospital-based and 1,267 of whom were office-based. Eighty-seven percent of respondents used an EHR.
Ultimately, the patient interaction portions of the survey revealed four common themes amongst all provider types. However, the prevalence of those themes varied between office- and hospital-based providers.
More hospital-based physicians were concerned that EHR charting and administrative tasks kept them from spending time with their patients. Hospital-based clinicians could not spend as much time at the patient bedside because they needed to document on their computers that are usually kept in offices separate from exam rooms.
Conversely, office-based clinicians were more concerned with EHR effects on the quality of a patient interaction. Office-based clinicians typically keep their computers in their exam rooms, and therefore use the tool simultaneously with conducting patient visits.
Respondents specifically said decreased eye contact and depersonalization was a prominent subtheme for reduced patient interaction quality.
“Comments included words such as intrusive, impersonal, limits, interferes, distracts and disruptive to describe how using an EHR affects patient interaction, and physicians often referred to the EHR as a barrier,” the researchers wrote.
A small population of respondents said physician EHR use had no impact on patient-provider interactions. As the third most common theme, this statement resonated primarily with office-based clinicians. Office-based clinicians are more likely to have reworked their clinical workflows to reconcile the patient interaction with technology use.
Hospital-based clinicians also stated that EHRs improve access to patient data, which in turn improves patient interactions. Having access to lab results or problem lists helps hospital-based clinicians prepare for patient interactions.
The EHR can also enhance communication if providers use the tool to look at test results alongside the patient and incorporate the patient into EHR use time. Office-based clinicians use the strategies more often than hospital-based clinicians.
Ultimately, the differences in perceptions about EHR use on patient interactions varied from hospital- and office-based clinicians likely because of the setup of their workspaces.
“The difference in frequency of the top two themes likely reflects fundamental differences in how inpatient and outpatient physicians work, with hospital-based physicians frequently using computers situated outside of patient rooms and office-based physicians increasingly bringing laptops into exam rooms,” the researchers explained.
Despite these differences, conclusions are clear: both office- and hospital-based physicians must leverage communication strategies to improve patient interactions with EHRs.
Researchers recommended putting the computer monitor in the patient’s view so that physicians’ backs are not turned toward patients. Providers should also show patients the screen when reviewing lab results or giving sensitive news.
Physicians in all practices should also “Honor the Golden Minute,” and engage in meaningful relationship building with the patient prior to EHR use.
As EHR use continues to pervade the industry, clinicians must determine the best strategies to preserve positive patient-provider relationships amongst health IT use.
“Physicians widely acknowledged EHRs as a permanent presence, saying they must adapt their work and workflow,” the researchers pointed out.
“Addressing these findings will require more than simply incorporating strategies to use an EHR in a more patient-centered way,” the team concluded. “Future in-person research through focus groups or key informant interviews could investigate the derived themes in more detail and further explore feasible opportunities to address our findings.”