Most people agree that Electronic Health Records (EHRs) have significantly changed the way physicians conduct exams. But there is some debate as to whether or not that change helps physicians and patients communicate better.

Do EHRs live up to their promise of making patient information more accurate and accessible at the point of care? Or do computers (and tablets) create barriers between patients and physicians?

To help improve patient-physician relationships, the American Medical Association (AMA) recently researched the effect of electronic devices on communications in the exam room.  It reviewed more than a dozen studies on the topic and revealed plans to encourage EHR adoption in a recent report.

Physician actions shape patient perception of EHRs

Research indicates that EHRs do not negatively affect patient satisfaction. In fact, one study found that exam room computing helped improve communication about medical issues, comprehension about decisions and overall visit satisfaction.

During effective clinical encounters, EHRs are becoming a third participant in communications between patient and physician.  Some authors suggest that computers enable better sharing of information – and decision-making power — during the consultation.

Effective communication with an EHR largely depends on the physician’s skill set.  According to one researcher, “Physicians with good baseline communication skills tend to integrate exam room computing into their relationship with patients, whereas physicians with poor baseline skills tend to create communication barriers when using computers in the exam room.”

The factor that most consistently influences patient perception of EHRs: physician attitude. If they embrace the technology and the value it brings, then so will patients (click to tweet this idea).

Small steps can help minimize disruption

Physicians who successfully incorporate computers and EHRs take an “inclusive” approach in the exam room. For example, they might install mobile monitors so patients can see the data, too. Or they use devices in a way that they can easily maintain eye contact with patients.

The room needs to be arranged so that the physician is facing the patient during conversation.  Physicians should position the computer so the patient is not looking at the physician’s back.

Throughout the visit, it’s important for physicians to explain what they are doing behind the keyboard. If they are ordering lab tests or logging off to protect patient privacy, a little information can help relieve uncertainty.

AMA encourages effective EHR adoption

The report concludes with two action steps regarding exam room computing and EHR use, adopted by the AMA:

1)      AMA will share tips and resources with physicians through AMA publications

2)      AMA will encourage physicians to seek feedback from patients through satisfaction surveys

These are two important steps in fully integrating EHRs into the exam room. What else do you think needs to happen to integrate them into patient-physician communications?

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About the author

Rick Mansour, MD, is vice president solutions management for core clinical and departmental solutions at Allscripts. In this role, he combines his medical and software development knowledge for better clinical outcomes. His special interests include clinical decision support programming, Arden Syntax, relational database structure and query language. Prior to joining Allscripts (initially as chief medical information officer for Eclipsys), Dr. Mansour served as chief of hematology and medical oncology at Freidman Clinical Internal Medicine. He also is an associate professor of Medicine and supervises fellows clinic at the Feist-Weiller Cancer Center at LSU Health -Shreveport.

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