As I was thinking about this month’s blog, I came across several articles discussing the relationship of technology to patient care. There are many opinions discussing the impact of technology, and specifically the electronic health record (EHR) on patient relationships. It begs the question: Can we be efficient clinicians and also connect with a patient even though we are facing a computer with an electronic record demanding data input?
Often, there are four central themes to consider:
- Maximize the patient encounter: Does the EHR and all of the data it requires minimize our ability to connect with patients? When we are addressing sensitive personal issues, can we effectively listen? In my own experiences, I am careful to do the following during the encounter (despite my laptop being present):
- Greet the patient, introduce learners, acknowledge if you are running late
- Maintain eye contact
- Do NOT type if a patient is crying or emotionally labile
- Sit down when taking the history
- Leave the laptop, wash your hands and do the exam, focusing on the patient the entire time
- Resume the last details with the laptop if needed (prescriptions, orders, etc.)
- Conclude the visit with a clear expectation of when you will see him/her again in follow-up
- Maximize reimbursement: It can be great to have coding resources at your fingertips as part of your EHR, but is templating dangerous? In a world of cutting and pasting, it can be really easy to document a comprehensive physical exam. The challenge is to ensure that your documentation genuinely matches the work you did as well as the medical necessity for that work. Alternatively, creating electronic shortcuts for common patient care modalities, such as smoking cessation or counseling on diet and exercise, may allow you to capture additional revenue for work done and properly documented during a patient visit.
- Improve patient care: In this era of meaningful use, EHRs are enhancing our ability to care for populations of patients. For example, you can use the EHR as a tool to gather all of your diabetic patients, and then drill down and measure their disease control by running a report on all diabetics with a hemoglobin A1C greater than the goal of 7. As health information exchanges become more prevalent and evolve, we will also have the ability to exchange information on a given diabetic patient, both in the primary care office as well as the hospital. Cost control may be an additional benefit of improved provider communication. Physicians who had access to a health information exchange (HIE) ordered fewer lab tests for patients with prior test results after the HIE was formed than they did previously, according to a new study published in the Archives of Internal Medicine.
- Patients are people, too: One of my first clinical preceptors taught me very wisely that patients have basic physical needs as well as an emotional agenda of sorts for their healthcare visit. If you as a clinician do not satisfy their agenda, while only paying attention to yours, therein will arise conflict. Within a busy clinical day, we need to not only see our patients, but also complete their health record and address billing and coding to ensure reimbursement, not including completing many other non-reimbursable tasks. Keeping in mind these basic elements of human communication, we can all then focus on care for the patient rather than caring for the chart.