What impact does use of the EHR have on patient encounters?

The need to input certain information can distract you from focusing on what the patient regards as the most important issues to him or her. Most of these systems are oriented more around medical than around psychosocial concerns, so more work needs to be done on these systems to make sure that the patient can voice other concerns and that those concerns are not left behind.

Another impact of the EHR is that some clinicians engage in light chatting with patients to fill the silence while they are typing on the screen. This takes time away from the patient’s concerns and these clinicians are less likely to be rated as offering excellent patient care. The computer may not be the only reason for the patient’s dissatisfaction but it is an important one. Patients with barriers to care or complex issues may require more research on the part of the providers to find out what is going on. The literature is mixed on this point. But it is clear that there are more helpful and less detrimental ways to use the computer while also engaging patients.

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Do you have suggestions for providers seeking to improve patient encounters while also using the EHR?

It can be helpful to share the screen with patients, so they can see what you are doing while you are talking with them. This engages them in the process. Make sure to stop using the computer and look at the patient if he or she brings up something sensitive or concerning. Patients need to feel you have their full attention. While these suggestions have not been rigorously studied, they are common sense tips.

Exam rooms can be set up so that you can more easily share the screen with the patient or, at least, so that you can look at the patient without contorting yourself to also look at the screen.

Transparency is important. If you need to focus on the screen and enter information or write a prescription, explain to the patient in advance why your use of the computer is necessary. Most patients will understand when it is explained, which will facilitate communication. If you need to focus on the screen, you might use that time for the patient to read an educational handout about the new medication you are prescribing or about their illness or recommended action plan, such as weight loss. That way, patients can have their questions or concerns ready for when you finish entering the information on the screen.