- The ability to acknowledge and be transparent about clinician EHR use is yet another skill clinicians need in their patient-provider communication toolbelts, according to a new study published in the Journal of Medical Internet Research.
Health IT, and the EHR in general, has innovated the way providers deliver care, helping them to synthesize and access patient information in a digital format and making care more efficient. But EHRs have also forced clinicians to reevaluate how they build relationships with patients with a distracting computer screen demanding clinician attention.
Research has shown that patients report higher satisfaction when their provider spends less time looking at the EHR screen. To make this happen, providers have adopted two different multitasking strategies.
First, providers have developed the ability to document on the EHR while also eliciting information from patients, such as medical histories. Second, providers have worked to document when the patient begins speaking with them about a medical need.
Although many healthcare providers have identified multitasking as a top strategy for reconciling health IT use and the patient experience, it does have its risks.
“Multitasking may increase the risk of making errors, either in communication with patients or in completing EHR tasks, such as documentation or computerized order entry,” the researchers said. “Meanwhile, using EHR systems in silence has been associated with lower patient satisfaction.”
In an observational analysis of continuing medical education workshops and lectures, 63 clinicians expressed concerns about medical errors resulting from EHR multitasking. Each of the participants reported “misses” (when an EHR mistake turned into a medical error) and “near misses” (when an EHR mistake was caught before it could turn into a medical error).
Specifically, the participants identified computer position, EHR system usability, note content, information overload, problematic workflows, systems issues, and provider and patient communication expectations as risk factors for misses.
The group worked together to determine strategies for reducing misses and near misses, with each of them hinging on improving patient-provider communication. Strategies included clinician transparency when needing silent EHR use time, narrating EHR use, patient activation during EHR system use, adapting visit organization and workflow, improving EHR system design, and improving care team coordination.
Fundamentally, integrating the EHR into the patient-provider relationship will require transparency and patient trust, one clinician said. This clinician respondent said he explains to the patient the imperative to use the EHR, but attempts to empower the patient to always call the provider’s attention when needed.
“Clinician transparency with patients about using EHR systems—including tasks such as prescribing that require focused attention to avoid errors—may result in fewer misses while preserving patient trust and satisfaction,” the researchers explained.
“As professional schools implement skills-based training in patient-provider communication with EHR system use, trainees may be able to practice empathic ways to negotiate the need for silent EHR use and ways to detect subtle queues from patients signaling that they need the clinician’s full attention.”
Very little is actually known about successfully integrating health IT and the EHR into the patient encounter. Patients want to their providers to see and hear them, but competing documentation requirements make that difficult to deliver.
Healthcare professionals must continue investigations into patient-centered EHR use to better design best practice standards.
“Future studies should explore diverse patient perspectives about clinicians’ EHR multitasking and their strategies for bringing clinicians ‘back to the present,’” the researchers concluded. “In addition, studies should examine how these strategies affect patient-important outcomes in quality and safety.”
From there, healthcare professionals can apply that knowledge to EHR training sessions. Pilot training programs have yielded positive results, research has shown.
At the University of Chicago’s Pritzker School of Medicine, clinical leaders assigned a training course to new clinicians to help them use the EHR in a more patient-centric manner. The training module only took about 20 minutes and was integrated into an overarching EHR training course.
After completing the training program, clinicians rated their readiness to use the EHR during patient encounters a 3.9 out of five points, an increase from the 3.11 points they reported prior to the module.
While the medical community continues to identify best practices for integrating the EHR into the patient-provider interaction, it will be essential to also design programs that deliver those best practices to end users.
“We found partnering with EHR trainers who deliver required onboarding training is a novel, timely, and effective method to facilitate training on patient-centered EHR communication strategies across a variety of residency and postresidency training programs,” the University of Chicago researchers concluded. “Similar training can be easily replicated at other institutions and may help ground trainees in best practices and contribute to cultivating a culture of high-quality patient care and meaningful, humanistic patient-centered EHR use.”