Balancing Act with EMR - Attention focused on Screen or Patient?

Who is not struggling with finding a balance between using technology to research and document versus the perception that 'I'm not listening'. The problem that all providers face is not how good you are at handling technology, but how do patients react? Technology is a double-edge sword. You want it (other than CMS mandating it), because it is supposed to make you more efficient, you don't want to take charts home. On the other hand, it can be a distraction if you don't pay attention to patients. Even worse, you are paying attention, but patients feel they are not being heard. Consequently, you don't want these patients to stop coming to you.

Let me first focus on the technology itself. There are multiple ways of using technology to chart in an EMR.

  1. Templates - point and click
  2. Typing
  3. Dictation
  4. Transcription services

Every individual is different. Some are good typists, some are fluent with 'point-n-click', some just love dictation. Majority of you fall somewhere in between. You must find your own sweet spot. Find a method that works well with you.

When I interact with providers, I actually help them find a way that works well for them. For example, here's a scenario:

"Dr. Smith is an OK technology user. She can google, use internet to search, use email quite effectively, and overall use a windows system quite well. On the other hand, her typing skills are not good. She actually hates typing. When she emails, she hunts and pecks the keyboard."

Armed with this information, the first thing I did is have her take a test of a dictation software like Dragon Medical. She did pretty good. Achieved almost 98% accuracy without any training at all.

After discussing a bit more, here is what we concluded. For Dr. Smith, the recommendation was -

Use templates (point and click) to chart important elements of the note while in the exam room with the patient.

  • Diagnosis
  • Orders/Procedures
  • Meds ePrescription

As soon as the patient leaves the exam room, she dictates her finding in detail under HPI and/or Plan.

Regarding other parts of documentation such as review of systems, physical finding, she chose to point and click after the patient left.

So, we found that in her case, this was the most effective method. It took her less than 5 minutes between patients to finish the encounter completely.

Will this work for you also? Maybe, maybe not. We have to figure out a way that works for you. But I know for sure that there are ways that will make YOU more efficient and effective.

Now, the second part. Managing Patient Perception and Expectation.

There are few things you can do to make sure that Patients know you are paying full attention to what they are saying, including their body language.

  1. Let me 'show' you. Immediately involve patients in the use of technology. Sharing a screen with past results, past prescriptions, and then asking them about it, engages them right away. Asking questions - 'Is that clear?', etc. makes them comfortable with the new you - you and technology together.
  2. You know you can multitask, but patients think they deserve and want your full attention. So, after that initial encounter with technology, turn around, face the patient and give them 100% of your attention. Let them know you care with thoughtful words and compassionate attitude.
  3. Now is the time to 'document', and so with patient's consent - 'let me make sure I document that' - turn your attention back to the computer, while talking all the time with the patient. If you are 'clicking' on a template and documenting a diagnosis code, say what you are doing, relating to and repeating what the patient told you. That way, as you are clicking, you are doing what good listeners do - feed it back - 'let me make sure I heard that right'.

Just this 1-2-3 step approach takes the fear of technology from your mind as well as that of your patients. If your software allows, use diagrams to draw and show patients what is going on. In other words, anything that you can do to make the computer part of the conversation rather than an adversary.

By examining your use of technology, we can ensure an even more professional human bond with your patients and increase efficiency for you at the same time.