Michael Crocetti, MD, Johns Hopkins Community Physicians
The Electronic Health Record (EHR) is a necessary clinical care tool that improves the quality of care we give to our patients. However, the EHR can be a barrier when trying to deliver patient-centered care. The EHR can be a distraction and lead to decreased presence during patient interactions. With that being said, there are three things that clinicians can do during the visit to improve engagement.
1.) Sit at the same level as your patient.
Begin with introductory comments, and let them know you’re going to be on the computer at times during the visit. I ask patients if it’s ok if I log in to the computer and I let them know I’ll be typing things sometimes so I can remember all that has been said.
2.) Face the patient for the majority of your time together.
It’s important to toggle back and forth from patient and computer so that the majority of the time you’re facing the patient in direct communication. This takes practice but becomes second nature after a while.
3.) Find times during the visit to use the EHR as a teaching tool for the patient.
Turn the screen towards the patient and have them look at their clinical information. In pediatrics, the one thing that I do at every well visit is show the growth charts to the patient and parent to engage them in the visit.
Balancing EHR documentation and direct patient interaction can be challenging, but practicing these three tips can improve both patient satisfaction and your joy in medicine.
What do you think?
Do you want to add to the conversation? Please share!
Panagis Galiatsatos, MD, Johns Hopkins University School of Medicine
I don’t use the computer when talking with patients. I listen, talk, and occasionally write with pen and pencil. If I need to look at a computer for anything, I turn it to my patient so they can see what I’m looking at. It might be more time consuming to do notes later, but it’s a price I pay to be able to interact with my patients in the same way I want a doctor to talk to me.
Roy Zielgelstein, MD, Johns Hopkin University School of Medicine
I spend very little of the visit at the computer.
There are really two reasons for that: it has a powerful—and I think often negative—effect on the patient, and it also has a powerful—and uniformly negative—effect on my ability to listen and be fully present.
When I do use the computer, typically at the end of the visit, it’s to share information with the patient, to confirm its accuracy, and to let the patient know how I’ve synthesized things and how I’m depicting that to others.
Sharon Solomon, MD, Johns Hopkins University School of Medicine
The volume of patients we see each day in clinic coupled with the need to perform diagnostic tests and to provide vision-saving treatments all during a single encounter present a challenge to the delivery of efficient patient care. The addition of electronic health records to the clinical scene has truly pushed physicians to the limit in their attempts to fully engage with patients.
One strategy that has been used by the Retina Division of the Wilmer Eye Institute is to employ scribes, who can record physical findings directly into EPIC, as the physician performs the examination—laying hands on the patient and simultaneously explaining to the patient what I’m seeing.
Additionally, I still keep an abbreviated hard copy of the patient’s encounter where I quickly jot down special inquiries, concerns, or social circumstances that are relevant to the patient’s care but which would require too much time to enter into EPIC during the encounter.
This allows me to maximize my interaction with the patient, to show the patient that I hear and am documenting his concerns, and to have a complete record of the encounter in EPIC, which facilitates the personalized delivery of subsequent care.
