EMRs a 'double-edged sword' for doc, patient communication
Policies promoting electronic medical record adoption should include communication-skills training for clinicians and those using the technology, according to a new study.
The study found that while EMRs assist physicians in real-time communication with patients during office visits, they can also be a distraction and take away from visits.
The study was conducted by the Center for Studying Health System Change, a nonpartisan policy research organization (HSC), and was supported by the Commonwealth Fund.
"Electronic medical records are a double-edged sword when it comes to communication with patients and other clinicians," said HSC Senior Researcher Ann S. O'Malley, MD, coauthor of the study with HSC Research Assistant Genna R. Cohen and HSC Senior Researcher Joy Grossman.
The study found that physicians generally believed EMRs helped them spend more time with their patients. As one physician interviewed said because, "we do not have to call down the hall for a lab or test result, we spend more quality time [with the patient] in a more context-rich way."
Physicians also believed that EMRs generally enriched patient education during visits and enhanced access between visits and reduced phone tag.
"These findings show that EMRs can indeed allow physicians to use time with their patients more effectively, for example by aiding in communication around treatment plans," said Commonwealth Fund Vice President Anne-Marie Audet, MD. "That could potentially translate into significant benefits for patient outcomes, as other studies have shown that engaged patients understand their health problems better and are more likely to follow their doctor's recommendations."
However the study also found EMRs posed some challenges for physicians when communicating with their patients.
An internist interviewed said, "My concern now is that we're listening less because we have more information when we walk in the room, and it's not all trustworthy." Another internist, (who works in both outpatient and inpatient settings), noted his fear that EMRs could greatly diminish real-time communication with patients. "A lot of us feel like we're already seeing it," he said.
Some physicians also suggested that by focusing on filling out checkboxes in the EMR they were reducing the amount of open-ended questions they asked patients, which they worried could lead to subtle or nuanced symptoms going unidentified.
"The study findings suggest that continued refinement of EMRs' design by vendors and their use by clinicians could help reduce the potential for distraction during patient visits," O'Malley said. "In particular, policies promoting EMR adoption should consider incorporating communication-skills training for medical trainees and clinicians using EMRs."
Authors of the study interviewed 52 physicians and other staff at 26 small and medium-sized physician practices with commercial ambulatory EMRs in place for at least two years, as well as chief medical officers at four EMR vendors, and four national experts active in health information technology implementation.
Click here to view more study findings.