February 23rd, 2018
The reviews of electronic health records are in and they are…mixed. While bringing medical records into the 21st century has made health data more accessible and made ordering more efficient, the effects on office workflow and clinician satisfaction have been less successful.
Physicians have expressed frustration with EHRs designed more for billing purposes than clinical documentation, saying that they distract from the doctor-patient interaction and waste hours of time. Previous research shows that doctors spend a much larger proportion of their day doing administrative EHR work than face-to-face with patients. Now, two new studies demonstrate how EHRs affect interactions with patients in the exam room or clinic.
We know that doctors spend more time in the day with the computer than with patients, but how does that translate to time spent in each clinic visit? Dr. Richard A. Young, director of research at the JPS Family Medicine Residency Program in Fort Worth, TX and colleagues directly observed almost a thousand primary care clinic visits across Texas to find out.
Their study, published in Family Medicine, found that primary care physicians spent more time in clinic visits face-to-face with patients than looking at the computer; but counting the time spent before and after the clinic visit, doctors spent more time working in the EHR than with the patient. Out of an average 35-minute visit, doctors only ended up spending 16 minutes face-to-face with patients.
Doctors have complained that needing to fill out EHR forms during patient visits makes it harder for them to listen to and connect with patients. But it’s difficult to prove that EHR use has a negative impact on doctor-patient interactions. Some argue that in this digital age, doctors should be able to multi-task, and interact with the computer and the patient at the same time.
A recent study in the Journal of General Internal Medicine sheds some light on the issue. Researchers in medicine and communications collaborated to view recordings of 217 patient encounters and used “meticulous coding” to find patterns in EHR use and patient behaviors. They found that doctors frequently interacted with the computer, clicking an average of 216 times per encounter and spending 8.9 minutes (almost half the visit) staring at the screen.
The more the doctor used the EHR, the less frequently patients asked questions or expressed concerns. And the longer the doctor spent looking at the screen, the more silence there was during the visit. On the bright side, EHR use was not correlated with doctors’ ability to start conversations with patients, showing that doctors are trying to engage patients while they use EHRs.
The authors suggest training physicians to be able to better multitask and to engage patients by showing them the EHR. But this would just be treating the symptoms, not the root cause of the problem, write Dr. Michael Hochman, in an accompanying editorial. We shouldn’t have to settle for clunky electronic records that take us out of the conversation with patients. We need an overhaul of EHRs, a “fundamental reboot,” that combines the technological advantages of EHRs with the user-friendly simplicity of pen and paper.