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Don't let EMRs cut into your doctor-patient time

A practical look at information technology issues and usage

By — Posted Sept. 21, 2009.

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Paul Roemer is in the health care technology business, but even he had a hard time dealing with what a computer screen was doing to his doctor.

Roemer, managing partner of Downington, Pa.-based consultancy Healthcare IT Strategy, noticed that his cardiologist, who normally looked him in the eye during a visit, instead barely glanced up from the computer resting on a small desk in the corner of his exam room. "We could have done the whole thing via WebEx," an online conferencing site, Roemer said. "It was disappointing."

Roemer's complaint is common among patients whose doctors bring information technology into their practice, particularly when the systems require physician input.

Studies have found that patients who feel rushed through an exam have lower satisfaction rates than those who feel their physicians spent an appropriate amount of time with them. And not maintaining eye contact is an easy way to make a patient feel rushed, experts say.

The computer does not have to get in between you and your patient.

Experts and doctors with technology experience have come up with various strategies to make sure the screen doesn't overtake the physician's attention. One easy-to-implement strategy: acknowledging the technological elephant in the room.

Letting patients know that because of the computer you might not be making constant eye contact with them can make patients feel more at ease, said Lyle Berkowitz, MD, medical director of clinical information systems for Northwestern Memorial Physicians Group in Chicago.

When he first started with EMRs in 2002, Dr. Berkowitz was on the other end of the experience Roemer had with his cardiologist. Dr. Berkowitz' patient stopped him in the middle of the exam and asked him to stop paying so much attention to the computer and focus more on her.

Dr. Berkowitz said he used the opportunity to explain to the patient the advantages of having the computer and how it helped him do his job.

He told her the computer was checking for possible drug interactions and was creating a record that could be accessed by another doctor if she ended up in the hospital. He also told her it was helping him create an accurate record of the care she received. His response satisfied the patient and he continued the exam. Even now, he says he will still occasionally say to a patient, "I promise I am listening to you very intently, I just need to need to look something up on here so go ahead and tell me what's going on."

Using the computer for documentation tells the patient, "I am not just saying it, I am writing it down," Dr. Berkowitz said.

Timothy Fiorillo, DO, a family physician at the Perkiomen Valley Family Practice in Collegeville, Pa., makes sure to divide his time between the patient and the computer. He typically allows the patient to talk for up to two minutes, while he looks at them and listens, before he types anything. At about 30 words a minute, Dr. Fiorillo thinks his typing abilities work to his advantage.

If you feel your typing skills aren't up to speed, choosing an EMR system that allows the use of dictation may be the answer.

But whatever type of program you choose, you still need to make an effort to become as proficient on it as you can be, Dr. Fiorillo said.

Often, experts say, the reason physicians aren't making eye contact with their patients is that the doctors are unfamiliar and uncomfortable with their new systems. By practicing scrolling through the most commonly used screens, physicians will learn to navigate the system quicker, allowing more face time with the patient.

Adopting an EMR also mean reorganizing the exam room or changing the order in which an exam is conducted, Dr. Berkowitz said.

After his group's system was installed, some doctors found that their patients were sitting on exam tables that left them, literally, staring down physicians' necks. The solution was a triangle set-up, he said.

The exam room is now set up to allow the patient, doctor and computer to form a virtual triangle so that the physician can look at the patient and the computer at the same time. At the beginning of an exam, Dr. Berkowitz says, he sits the patient on a bench in front of him with the computer screen in between them so eye contact can be maintained. Once the patient history is completed, it's on to the exam table. After the exam, the patient returns to the bench to go over instructions. This close proximity allows doctor and patient to share the computer screen, creating a more collaborative environment, Dr. Berkowitz said. He also can show patients previous lab values or educational material.

"The vast majority of patients love the EMR as long as they don't feel ignored," Dr. Fiorillo said.

Roemer agreed, saying he decided to give his own physician a break and not complain about the lack of eye contact during his last visit. The doctor was just trying to make it through the learning curve, he said.

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