How to improve patient satisfaction with electronic records

by John Rossheim

To many physicians, it may appear self-evident that electronic records will improve the patient experience. After all, the doctor has speedier access to notes, labs and other patient data, and that’s got to increase the patient’s confidence in the doctor’s understanding of his health status.

But whether patient records are confined to a private-practice EMR or live in an EHR system, the usefulness of electronic records can be undercut by clinicians who don’t consider how this technology affects patients. It comes down to this: “If patients don’t understand that the technology is there for their benefit, that it’s a safety and quality measure, they may see it as a barrier to their relationship with their physician,” says Barry Chaiken, M.D., immediate past board chair of HIMSS and CMO of Imprivata, which makes data-security software.

Fundamental benefits of electronic records appeal to patients

Physicians must routinely demonstrate to patients how electronic records are facilitating and often improving their care.

For patients, it all begins in the doctor’s office. To forge a connection between electronic records and the perception of quality of care, physicians in private practice can highlight a basic selling point: No matter how thick the patient’s chart or how byzantine the lab results, the doctor can quickly locate any and all relevant information.

When physicians use technology effectively during an exam, patients intuitively understand the benefits. “Any of my doctors can pull up my info that any other doctor inputted, as well as all lab and test results,” says Laurie Allen, recently an outpatient at The Mount Sinai Medical Center in New York City. “There’s no reason for one of my doctors to contact another just to get information. It’s all in the system, which is much more efficient for everyone.”

That efficiency speaks volumes to patients when they’re waiting anxiously for a physician to discuss test results, whether it’s in their primary care physician’s examining room or on an inpatient ward. “For patients, it’s great not to have to wait for the doctor to find a particular piece of paper,” says Dr. Chaiken.

Caveat doctor: Face time trumps screen time

If patient satisfaction wanes, however, the fault may lie with how physicians incorporate the technology into their face time with patients. Doctors who fail to consider the patient’s perspective are more likely to alienate them with innovation.

For example, “some patients think the physician spends too much time looking at the screen rather than at them,” says Abraham Seidmann, a consultant on medical informatics and professor at the Simon Graduate School of Business at the University of Rochester.

It’s also critical for doctors to use a system that suits their specialty and workflow, and doesn’t derail communication with the patient. “Interaction between patient and physician in the exam room can be problematic with EMR,” says Bertie Bregman, M.D., a member of the clinical faculty at New York-Presbyterian Hospital/Columbia. With some systems, “you have to hunt and point and click and switch between screens.”

Low-tech thoughtfulness must accompany high-tech innovation

The configuration of the examining room can help shape the patient’s experience with electronic records. “Years ago, doctors had their backs to their patients when they used an EMR,” says Dr. Chaiken. Now more physicians have rearranged their workspaces so that they make eye contact with patients as they use their computers, he adds. Similarly, some hospitals use handheld or laptop computers or mobile PC workstations to enable flexibility in the physical arrangement of patient, clinician and the devices that display electronically stored data.

Re-enforcing the basics of face-to-face communication also helps. “Doctors can successfully bridge the distance created by electronic-records systems by taking the time to talk directly with their patients, improving eye contact and reducing screen-gazing activity,” says Marshall Freeman, M.D., a neurologist specializing in headache.

Physicians often improve patient satisfaction with electronic records by demonstrating their power. With an EHR, doctors are better able to educate patients about their health, using graphical presentations of test results for example, says Seidmann. And when patients understand their health status, they’re likely to be more satisfied with their care. Dr. Chaiken puts it this way: “Get patients involved with EHR and they will embrace it.”

This approach is backed up by research. “If the patient felt actively involved and perceived that the physician liked the computer, high levels of satisfaction were reached,” according to a study of the effects of an EHR implementation at Baldwin Park Medical Center in Baldwin Park, Calif.

John Rossheim is a regular contributor to Curaspan Health Group’s Knowledge Exchange.

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