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Communication in the EMR Setting

Best practices for overcoming obstacles to patient-centered technology

By Elizabeth Sidney

Rather than being a boon to care, studies have begun to confirm the potentially harmful impact of EMRs in the exam room. The technology interferes with communication. Though health professionals get little to no training in the skills and behaviors needed to use EMRs effectively, that is now changing.

A Chicago Medical Society CME lecture on Feb. 10 introduced one such initiative. Developed by University of Chicago doctors, the workshop educates future physicians on how to use EMRs to enhance patient-doctor communication. One of the U of C team members behind this effort led CMS participants through an interactive session.

A short video depicts a patient-physician encounter, highlighting instances of less than ideal communication. Presenter Wei Wei Lee, MD, MPH, follows up with a debriefing of how various aspects of the experience can be improved. She and the audience review environmental barriers such as room set-up, verbal and non-verbal communication, and workflow/technical issues.

Patient-Physician Dynamic

Inspiration for the workshop came when young U of C doctors, completing their clinical rotations, observed how the presence of computers in the exam room changed the dynamic between patients and doctors, Dr. Lee said. The computer amplified skills for those who communicate well without a computer, but made things worse for those who do poorly without a computer, Dr. Lee noted. The team observed other behaviors such as poor eye contact, long silences, typing during sensitive discussions, facing away from the patient, and computer-guided questioning.

For Dr. Lee, a primary care physician and self-described humanist, she sees more and more of the “iPatient” these days. The term was coined by physician and author Abraham Verghese, MD. These virtual patients exists only on the computer screen as a set of data points, not as a human being in the room, lying on the exam table or hospital bed.

Observations such as these prompted Dr. Lee and colleague Maria Alcocer Alkureishi, MD, to pursue a group fellowship project on incorporating computers into clinical practice. The project targets second-year medical students. Ultimately, the team came up with a framework that can be adapted for instructing learners of all ages. The workshop video is an outgrowth of the project.

Clear Set of EMR Competencies

The U of C initiative aligns with the goals of several national organizations. For instance, the Alliance for Clinical Education guidelines recommend that medical schools develop a “clear set of competencies” for EMR use. Students must master the EMR prior to graduation to ensure they are ready for clinical practice, Dr. Lee noted. Also, the ACGME requires that residents “utilize information technology with sophistication” as part of practice-based learning and improvement.

Results of the U of C effort are so far positive. Students report greater knowledge and skill in this area, while their practical performance also improves, Dr. Lee said.

In spite of the challenges EMRs create for all physician age groups, Dr. Lee is quick to point out the positive aspects. EMRs decrease the amount of time charting, aid with population health management, and allow doctors to recap a conversation when they type in data.

A final piece of advice: “Always explain what you’re doing, pointing out things on the computer screen for patients,” Dr. Lee said. “The patient should also know the physician is logging off.”

The lecture was part of a series to help CMS members understand and benefit from new technologies. Other recent sessions have reviewed telemedicine.

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