EHR Enhanced Communication During Clinical Encounters

Patient engagement can be a key to reducing physician burnout, but EHR burdens can negatively affect patient-clinician interactions. Patient-centered EHR use is a well-researched field. Lee et al. developed a mnemonic to remind clinicians of patient-centered EHR strategies: HUMAN LEVEL.

Using the EHR as a Patient Engagement Tool

The obtrusiveness of the EHR can be managed and even be turned into a patient engagement tool by using a combination of strategies. The strategies below include and add to HUMAN LEVEL.

Staging and Equipment

• Ensure that the exam room is arranged correctly. (Use the triangle of trust)
  The chairs, examination table, monitor and keyboard placement should allow for good eye contact between the clinician and the patient. Create a triangle, with the clinician, patient and computer at the three corners.
  
  
• Use a widescreen monitor. (Let the patient look on)
  Using a larger monitor makes it easier for both the clinician and patient to review information and also maximizes the amount of information that can be shared without scrolling.
  
  
• Get a quiet keyboard.
  The sound of a loud keyboard can be distracting to both the clinician and patient.
  
  

Before the Encounter

• Get the patient’s record ready before the encounter. (Acquaint yourself with the chart)
  When you enter the patient’s room, you should be able to immediately access the patient’s record. Do not waste crucial initial minutes frantically searching. Briefly review the patient’s record before entering the room, and if possible, prepopulate it with the most recent information you’ve received.
  
  

During the Encounter

• Make introductions without technology. (Honor the golden minute)
  Start the encounter without any electronics. Greet the patient and listen to his or her concerns. Following the “golden minute,” introduce the EHR, explain the necessity of entering data into the EHR, and offer the opportunity for the patient to observe while you are entering information.
  
  
• Make the patient part of the EHR experience. (Maximize patient interaction / Explain what you are doing / Value the computer)
  Help the patient understand the value of getting the correct information into the EHR. Try to instill in the patient some pride of ownership of the information. Take a moment to show the patient what the EHR has to offer, and how it can facilitate the patient’s well-being. When looking up a lab value, invite the patient to view the labs with you. Use the opportunity to explain the meaning of various laboratory values and show the patient how their lab values have trended over time. Engaging patients in this way may prompt them toward greater participation — for example by being introduced to their chronic disease trend data. The encounter might look something like this:

Clinician: “I'm going to take a look at your PT/INR levels. Do you want to look at the trends with me?”

Clinician: “Overall things look good, but there are things you can do to continue to keep these levels in a safer range…”

• Periodically look the patient in the eye. (Nix the Screen / Eye Contact)
  Give the patient your undivided attention when appropriate. When discussing sensitive topics, it is best to focus on the patient, not the screen.
  
  
• Talk aloud while you are typing.
  Talking through and demonstrating the information-gathering process can fill awkward pauses in conversation that occur when an EHR task is being completed.
  
  
• Consider improving your typing skills.
  According to a National Health Service Publication, a physician who does hunt-and-peck typing averages about 30 words per minute, which is just slightly slower than an average writing speed. Learning to touch-type can significantly increase typing speed and increase eye contact between physician and patient. A proficient touch typist rarely looks at the keyboard and can achieve an average of 65 words per minute.
  
  

EHR-Enhanced Communication Resources

Breaking Away from the iPatient to Care for the Real Patient: Implementing a Patient-Centered EMR Use Curriculum
This tool kit focuses on patient-centered EHR use and best practices. It includes a PowerPoint lecture on patient-centered EHR use and best practices; two teaching videos featuring a less-than-ideal and a more-ideal patient-provider interaction; and accompanying worksheet and pocket cards to summarize best practices for patient-centered technology use in both outpatient and inpatient settings.

Enhancing Patient-Centered Communication and Collaboration by Using the Electronic Health Record in the Examination Room
This article examines the link between EHR-enhanced communication during the clinical encounter and the enhanced relational quality of the patient-physician relationship.

Top 10 Tips for Effective Use of Electronic Health Records
This article provides tips for maintain quality of care while transitioning from a paper-based charting system to EHRs.

Eight Tips for Patient-Centered EHR Use
This article presents strategies for entering patient information into the EHR while in the examination room with the patient.

Strategizing EHR Use to Achieve Patient-Centered Care in Exam Rooms: A Qualitative Study on Primary Care Providers
This article discusses how clinicians maintain rapport and effective communication with their patients to meet their individual needs, while managing EHR demands during patient visits.