A recent study sheds more light on the increased use of electronic health records by clinicians currently while talking to patients. As innovative as this system may be, it carries the risk of reducing patient satisfaction and greater error due to multitasking.
Electronic Health Records (EHR) have become an integral part of the health system in the last couple of years. Hospitals introduce this as a new storage system to reduce the amount of paper storage for patient’s information. They are an electronic recording of patient’s history, physical examination, investigations, and management plans. EHRs make information secure and readily available on a secured server for health professionals and can be transferred easily between hospitals.
Approved by the institutional review board of University of California, San Francisco, the study, published in JAMA Internal Medicine, was observational in nature and looked at the period between 2013 to 2015. The researchers chose clinics that had recently changed from being non-electronic to completely functional on an Electronic Health Records system. These clinics ranged from primary care providers offices to specialty health centres where the participants were patients, clinicians, and nurse practitioners. The eligible study participants had to undergo training to use the electronic health records and learn to communicate with the tools that it provided as research assistants recorded the data on video. The participants gave consent before test initiation and spoke in English or Spanish. While doing the analysis, data were taken from 25 health professionals and 25 patients.
Data collected from the participants were coded into the following categories: 1. Multitasking Electronic Health Records use (while the clinician and the patient were speaking), 2. Silent EHR use (3-second silence in-between the interaction), 3. Education with an EHR (the patient understands disease formation, procedure, and treatment regimens with the help of the EHR), 4. Education with paper (the patient understands disease formation, procedure, and treatment regimens with the aid of paper), 5. Physical Examination, 6. Focused Clinician-Patient talk.
Results showed that clinicians usually multi-tasked during a patient interaction. To document data the clinician would slip into the silent Electronic Health Records use, and this transition happened differently for doctors. Some would let the patient know of their transition while others ambiguously went onto the Electronic Health Records system without informing the patient. It was noticed that patients broke this phase by trying to communicate with the clinician, the topic of conversation varying between social and medical subjects.
While certain aspects of the Electronic Health Records program does require focus on the part of the doctor, the downside of that is that it takes away from the focus of the patient. The research showed that as the clinicians multi-tasked by talking to the patient while filling the different sections of the Electronic Health Records form, it increased their risk of error in entering patient data including potentially missing important aspects of the patient’s concerns. Most clinician-patient interactions showed the clinician dominating the conversation when not on the Electronic Health Records system. From other studies, it is shown that this behaviour decreases patient satisfaction and leaves patients with a sense of not being heard.
While the positive aspects of the Electronic Health Records system are apparent, a focus should be drawn towards bridging its use with increased engagement of patients and reminding clinicians to develop a method by which they can allocate time to resolve emerging patient concerns.
Written by Dr. Apollina Sharma, MBBS, GradDip EXMD
Reference: Ratanawongsa Neda, et al. “Multitasking and Silent Electronic Health Record Use in Ambulatory Visits.” JAMA Internal Medicine (2017).
