Physicians who use electronic health records, or EHRs, in their practices know that the technology has the potential to boost communication with patients, staff members and other clinicians. But results of a study conducted by the Center for Studying Health System Change, or HSC, indicate that EHRs also can hamper communication efforts in the health care setting.
"Electronic medical records are a double-edged sword when it comes to communication with patients and other clinicians," said HSC senior researcher and study co-author Ann O'Malley, M.D., M.P.H., in an April 7 news release(www.hschange.com).
She said study findings suggest that EHR vendors and the practices that use EHRs need to do more to reduce the potential for distraction during patient visits. For vendors, that means incorporating product design changes; physicians might consider additional staff training.
O'Mally also called for incorporating communication-skills training in future government policies that promote EHR adoption.
Authors of the study "Electronic Medical Records and Communication with Patients and Other Clinicians: Are We Talking Less?(www.hschange.org)" gathered information via telephone interviews with 52 clinicians in 26 small- and medium-sized physician practices with ambulatory EHRs in place for at least two years. Additional interviews were conducted with medical directors of four EHR vendors, as well as with four leading health information technology implementation experts.
The study was funded by The Commonwealth Fund.
In general, physicians indicated that EHRs allowed them to spend more face-to-face time with patients. "We spend more quality time in a more context-rich way," said one physician.
Physicians also highlighted such positives of EHR communication as enhanced patient education opportunities and e-mail access.
On the other hand, some physicians admitted that computers could be a distraction. One participant said, "It's like having a 2-year-old in the room." Many EHRs are loaded with "gadgets and gizmos" that can pull a physician's attention away from the patient. For example, instant messages that pop up on the computer screen can interrupt physician/patient communication.
The availability of vast amounts of health information at a physician's fingertips also can be a liability, said some respondents. For example, a lot of patient information is available electronically to the physician before he or she ever sees a patient, leading one physician to comment, "We're listening less because we have more information when we walk in the room."
Checklists embedded into patient charts can be overused and can reduce the number of open-ended questions physicians ask their patients, said some physicians. This undermines valuable interaction in the exam room.
Researchers also learned that EHRs could impede communication within a practice or between clinicians. Some respondents noted that the convenience of e-mail and instant messaging "decreased the likelihood that real-time communication would occur when needed most, for example, during patient emergencies."
"You have to use electronic communication when appropriate and voice when appropriate, and even paper when it's appropriate," noted one physician.
Respondents said for complicated patient situations, "Nothing should replace the interactive aspects of face-to-face or phone conversations." In addition, coordinating patient care between physicians is best handled with direct communication, said some respondents, noting that technology is not a good substitute for appropriate human interactions.