EHR in the Exam Room: How to Minimize Distractions and Engage Patients

With the rise of EHR implementation and usage, many people have voiced their concerns that the computer will come between the physician and his or her patient, causing a disruption in their communication and the clinical workflow. But over the past two decades, research has consistently found that using a computer in the exam room does not appear to negatively affect patient satisfaction.

The most significant factor in a patient’s perceptions of computer usage in the exam room is the physician’s attitude toward the computer. The more positive the physician’s attitude was perceived to be, the more likely that patient was to indicate a preference for computer usage.

In light of these findings, you may rest assured that you have control over how the computer impacts your patient interactions. So what can you do to limit distractions and maximize the benefits of exam room computing?

A number of factors influence the quality of physician-patient interactions when a computer is in the room—the most important one being the physician’s communication style. Consider how you interact with patients in the exam room while you’re using a computer. Do you primarily engage with patients and allow their narratives to lead the discussion, turning to the computer only here and there? Or do you find yourself focusing on the computer screen and using its prompts to guide the conversation? A communication style that centers on the patient—and uses the computer as merely a tool to enhance the conversation—is best.

Other factors to keep in mind include:

The positioning of the computer: Flat-screen computers mounted on mobile arms, tablets, or laptops allow for easy viewing for you and the patient. Engage patients by pointing to the screen and telling them what you’re doing as you’re doing it.

• The physician’s proficiency with the computer, including typing ability and familiarity with the EHR: Get comfortable with the computer and the EHR system to cut down on distractions and keep the conversation going.

The technology—its structure, data input processes, and other aspects: Have nurses or medical assistants input the basic patient information and check on preventative services so your time spent with patients is focused on their health concerns. Resist the urge to use electronic templates to guide your discussion.

The team’s acceptance of exam room computing: As stated above, your attitude toward computer usage will impact how your patients feel about it. So maintain a positive outlook when working with and speaking about the EHR system.

The bottom line? Your behavior impacts how effectively the computer will be integrated into your patient-physician interactions. It’s possible to build trust and a personal connection with your patients—even with a computer in the room—but it all depends on your actions. So show patients the value in using a computer during their appointment and allow them to engage with it directly. And remember, sometimes it’s best to push the screen away and just listen.

Need an easy way to remember what to do? Kaiser Permanente has outlined five key communication behaviors that form the acronym LEVEL:

Let the patient look on
Eye contact with the patient
Value the computer as a tool
Explain what you are doing
Log off and say you are doing so

Now that the computer has become a third “partner” in the clinical experience, take time to think about how you’ll integrate it into your conversations with patients. Use the computer as a tool to enhance the exam room experience, not as a distraction that drives the discussion. By being mindful of your communication style and computer usage, you’ll be able to keep the focus on your patients, further engaging them in your EHR system—and their own healthcare.


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