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 “Many clinicians worry that electronic health records keep them from
connecting with their patients,” said Dr. Neda Ratanawongsa of the
University of California, San Francisco, who co-authored the
research letter.
“So it's not surprising that we found differences in the way
clinicians and patients talk to each other,” she said.
But doctors who used the computer more also spent more time
correcting or disagreeing with patients, she told Reuters Health by
email.
The researchers used data from encounters between 47 patients and 39
doctors at a public hospital between 2011 and 2013.
The patients had type 2 diabetes, rheumatoid arthritis or congestive
heart failure, and sometimes more than one of those chronic
conditions. All spoke English or Spanish. Researchers interviewed
them by phone before their appointment, videotaped the appointment,
and interviewed the patients again after their visit.
Using the tapes, the researchers rated how much each physician used
the computer during the appointment on a scale from one to 12. The
electronic health records could be used to review test results,
track health care maintenance, prescribe medications and refer
patients to specialists.
In the post-appointment interview the patients rated the quality of
their care over the past six months.
About half of the 25 encounters with high computer use were rated as
“excellent care” by the patients, compared to more than 80 percent
of the 19 encounters with low computer use, as reported in JAMA
Internal Medicine.
Doctors who spent more time using the computer spent less time
making eye contact with patients and tended to engage in more
“negative rapport building,” correcting patients about their medical
history or drugs they’ve taken based on information in the
electronic record.
That’s not necessarily a bad thing, Ratanawongsa said.
“For example, a primary care provider says, ‘No, the cardiologist
actually wants you to stop taking that medication,’” she said.
“Electronic health records give important health information to
clinicians, which may help safety net patients with communication
barriers like limited health literacy and limited English
proficiency.”
Problems in care may lead to more computer use, which would explain
the link between computer use and lower patient satisfaction, she
said.
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“On the other hand, maybe patients sense that their clinicians
aren't listening as carefully to them,” she said.
Doctors who spend most of the time looking at the computer may miss
out on an emotional connection with the patient, said Richard M.
Frankel of the Indiana University School of Medicine, Indianapolis,
who wrote an editorial accompanying the story.
“When people are paying attention to the same thing at the same
time, you get the best transmission of information,” Frankel told
Reuters Health by phone. “Technology in the exam room is neither
good nor bad inherently,” but doctors can use specific techniques to
help patients get comfortable with it, he said.
They should introduce the patient to the computer and explain how
and why they will be using it. If possible, it can be arranged so
both doctor and patient can see the screen, he said.
In addition, doctors can look up frequently and make eye contact to
reestablish the relationship, Frankel said.
“Just under half of my patients have limited health literacy and
about half speak a language other than English,” Ratanawongsa said.
“The computer helps me know about their health and their health
care.”
“The hard part is figuring out how to help care teams access and add
to this information AND still stay present with patients in the
room,” she said.
Electronic health records “need to be more usable so clinicians with
varying computer proficiency can use them without struggling and
diverting focus from patients,” Ratanawongsa said.
SOURCE: http://bit.ly/1NiCTWw JAMA Internal Medicine, online
November 30, 2015.
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