Are there alternatives to using the EHR during the patient encounter?
Some providers or institutions use medical scribes to enter the information into the computer so that the provider can look at the patient without needing to look at the screen, and the information continues being recorded appropriately. There are pilot programs exploring wearable cameras that might allow someone in another room to access and type up the patient encounter.2,3 However, some patients may have privacy concerns if a third person is present in the exam room, or if they know that there is a technology transmitting the content of their appointment to a third party in another room. These patients may feel inhibited from talking about sensitive subjects such as erectile dysfunction or personal violence. So those approaches need more research to know how best they can be applied and when they are or are not appropriate.
Medical assistants may play an expanded role, not only as simple scribes but also as high-functioning team members. They can conduct pre-visit assessment of the patient’s condition or complaint, ascertain what medications the patient is taking, whether the patient has any allergies, and other relevant information. The medical assistant can also do post-visit education. Patients are often glad when the medical assistant is involved with their care, and the burden on the physician is reduced.
One alternative I do not recommend is taking notes during the encounter and typing them in to the EHR after the last patient has left because it is is a process that takes hours. There is a risk that many providers will be driven away from medicine because it is no longer fulfilling. They will feel they are spending most of their time just keeping up with their computer work and are no longer able to focus adequately on their patients.
Do you have any additional perspectives?
The burden of creating and implementing strategies to address shortcomings in current EHRs should not rest exclusively on the shoulders of physicians and providers. This is a system-wide issue and on a larger systemic level, we have to look at what can improve the role of the EHR in patient care.
1. Pelland KD, Baier RR, Gardner RL. “It’s like texting at the dinner table”: A qualitative analysis of the impact of electronic health records on patient-physician interaction in hospitals. J Innov Health Inform. 2017 Jun 30;24(2):894.
2. 15 things to know about Google Glass in healthcare. Becker’s Health and IT CIO Review. June 3, 2014. Available at: https://www.beckershospitalreview.com/healthcare-information-technology/15-things-to-know-about-google-glass-in-healthcare.html. Accessed: December 18, 2017.
3. Dougherty B, Badawy SM. Using Google Glass in Nonsurgical Medical Settings: Systematic Review. JMIR Mhealth Uhealth. 2017 Oct 19;5(10):e159.
4. Adewale V, Anthony D, Borkan J. Medical assistants’ roles in electronic health record processes in primary care practices: the untold story. J Med Pract Manage. 2014 Nov-Dec;30(3):190-6.